Hirose Tomoya, Shimizu Kentaro, Ogura Hiroshi, Tasaki Osamu, Hamasaki Toshimitsu, Yamano Shuhei, Ohnishi Mitsuo, Kuwagata Yasuyuki, Shimazu Takeshi
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
Department of Clinical Quality Management, Osaka University Hospital, Osaka, Japan.
Clin Nutr. 2014 Feb;33(1):179-82. doi: 10.1016/j.clnu.2013.11.017. Epub 2013 Dec 14.
BACKGROUND & AIMS: Protein metabolism is important in healing wounds, supporting immune function, and maintaining lean body mass. Determination of adequate requirements of amino acids has not been thoroughly clarified in critically ill patients. The purpose of this study was to evaluate 23 plasma amino acids in patients with sepsis and determine prognostic factors.
This study was a retrospective study. Plasma aminograms were measured in patients with sepsis. We evaluated minimum and maximum values of each amino acid and evaluated prognostic factors by multivariate logistic regression analysis and classification and regression tree (CART) analysis.
The study comprised 77 patients. The median intensive care unit (ICU) stay was 30 days (interquartile range 19.5-55.5 days). Whole mortality rate was 39.0%. Maximum values of glutamine, glutamate, glycine, alanine, methionine, phenylalanine, and histidine and minimum values of glutamate, taurine, serine, isoleucine, leucine, tyrosine, ornithine, tryptophan, and arginine were significantly different between survivors and non-survivors (P < 0.05). Statistical analysis using CART analysis revealed the minimum value of glutamate and maximum value of methionine to be significant prognostic factors for mortality (P < 0.05).
Plasma aminograms were significantly altered in patients with sepsis. Altered balance of aminograms was significantly associated with mortality in patients with sepsis requiring a long ICU stay.
蛋白质代谢在伤口愈合、支持免疫功能和维持瘦体重方面至关重要。危重症患者氨基酸的充足需求量尚未完全明确。本研究旨在评估脓毒症患者的23种血浆氨基酸水平，并确定预后因素。
本研究为回顾性研究。测定脓毒症患者的血浆氨基酸谱。我们评估了每种氨基酸的最小值和最大值，并通过多因素逻辑回归分析和分类回归树（CART）分析评估预后因素。
该研究纳入77例患者。重症监护病房（ICU）住院时间的中位数为30天（四分位间距19.5 - 55.5天）。总体死亡率为39.0%。存活者与非存活者之间，谷氨酰胺、谷氨酸、甘氨酸、丙氨酸、蛋氨酸、苯丙氨酸和组氨酸的最大值以及谷氨酸、牛磺酸、丝氨酸、异亮氨酸、亮氨酸、酪氨酸、鸟氨酸、色氨酸和精氨酸的最小值存在显著差异（P < 0.05）。使用CART分析的统计分析显示，谷氨酸的最小值和蛋氨酸的最大值是死亡率的显著预后因素（P < 0.05）。
脓毒症患者的血浆氨基酸谱有显著改变。氨基酸谱平衡的改变与需要长时间入住ICU的脓毒症患者的死亡率显著相关。
