Ceballos I, Chauveau P, Guerin V, Bardet J, Parvy P, Kamoun P, Jungers P
Laboratoire de Biochimie Médicale B, Hôpital Necker-Enfants Malades, Paris, France.
Clin Chim Acta. 1990 Apr 30;188(2):101-8. doi: 10.1016/0009-8981(90)90154-k.
In order to assess the influence of renal failure and nutritional status on the fasting concentrations of free plasma amino acids, we studied 81 ambulatory adult patients with varying degrees of chronic renal failure. Each of the patients was in good general and nutritional condition. Compared to 33 healthy controls, patients with mild renal failure (Ccr greater than 25 ml/mn) exhibited significantly (p less than 0.01, Student's t test) raised concentrations of cystine, citrulline, ornithine, taurine and 3-methyl-histidine and low level of serine. Concentrations of cystine, citrulline, and 3-methyl-histidine in plasma but not of taurine or ornithine rose in parallel with the progression of renal failure. A significant, but moderate decrease in valine, leucine and isoleucine concentrations was observed in patients with the most marked degree of renal failure (Ccr less than 10 ml/mn). We conclude that changes in the plasma concentration of several non essential amino acids are already present in the early stage of renal failure in patients with no sign of protein malnutrition: these may result from altered metabolic pathways of amino acids related to uremia and/or nephron loss per se whereas the moderate decrease in branched-chain amino acids that is observed only in the advanced stage of renal failure may be, at least in part, nutritional in origin.
为了评估肾衰竭和营养状况对空腹血浆游离氨基酸浓度的影响，我们研究了81例不同程度慢性肾衰竭的非卧床成年患者。每位患者的一般状况和营养状况良好。与33名健康对照者相比，轻度肾衰竭患者（肌酐清除率大于25 ml/min）的胱氨酸、瓜氨酸、鸟氨酸、牛磺酸和3-甲基组氨酸浓度显著升高（p<0.01，Student's t检验），丝氨酸水平降低。随着肾衰竭的进展，血浆中胱氨酸、瓜氨酸和3-甲基组氨酸的浓度升高，但牛磺酸或鸟氨酸的浓度未升高。在肾衰竭最严重程度的患者（肌酐清除率小于10 ml/min）中，缬氨酸、亮氨酸和异亮氨酸浓度出现显著但中度的降低。我们得出结论，在无蛋白质营养不良迹象的肾衰竭患者早期，血浆中几种非必需氨基酸的浓度就已发生变化：这些变化可能源于与尿毒症和/或肾单位丢失本身相关的氨基酸代谢途径改变，而仅在肾衰竭晚期观察到的支链氨基酸中度降低可能至少部分源于营养因素。
