Szpetnar Maria, Matras Przemysław, Boguszewska-Czubara Anna, Kiełczykowska Małgorzata, Rudzki Sławomir, Musik Irena
Chair and Department of Medical Chemistry, Medical University of Lublin, Lublin, Poland.
1st Chair and Department of General and Transplant Surgery and Nutritional Treatment, Medical University of Lublin, Lublin, Poland.
Adv Clin Exp Med. 2014 May-Jun;23(3):423-31. doi: 10.17219/acem/37140.
Total Parenteral Nutrition (TPN) is necessary in patients unable to receive oral or enteral feeding for a period of at least 7 days. Branched-chain amino acids (BCAA): valine (Val), leucine (Leu), and isoleucine (Ile) are essential amino acids, which are important regulators in protein metabolism. They are also the main nitrogen source for glutamine synthesis in muscles. In this process they undergo irreversible degradation and cannot be reutilised for protein synthesis. In catabolic states, like cancers, glutamine demand increases and therefore also its utilisation, which can decrease the level of BCAA required for Gln synthesis. The purpose of this study was to evaluate the necessity of BCAA or glutamine-enriched TPN in patients after gastrointestinal cancers surgery.
Our aim was to investigate changes of plasma BCAA and glutamine concentrations in patients operated for colorectal, small intestine or pancreatic cancer and who are either receiving TPN or not in the postoperative period. Free amino acids plasma concentrations were determined by the ion-exchange chromatography.
Surgery in the control group caused a decrease in Val, Ile and Leu concentrations in the postoperative period. In TPN patients this depression was inhibited beginning from the third day after surgery, except for Val and Leu in colorectal cancer group. In control and TPN patient groups, Gln concentration decreased after the surgery and subsequently increased beginning from the third day after the operation.
Gastrointestinal cancer patients' surgery results in decrease in BCAA concentrations. Standard TPN exerts a beneficial effect on the BCAA level in patients with pancreatic and small intestine cancer. In colorectal cancer such TPN should be enriched with Leu and Val.
对于无法经口或肠内喂养至少7天的患者，全胃肠外营养（TPN）是必要的。支链氨基酸（BCAA）：缬氨酸（Val）、亮氨酸（Leu）和异亮氨酸（Ile）是必需氨基酸，是蛋白质代谢的重要调节因子。它们也是肌肉中谷氨酰胺合成的主要氮源。在此过程中，它们会发生不可逆降解，无法再用于蛋白质合成。在分解代谢状态下，如癌症，谷氨酰胺需求增加，因此其利用率也会增加，这可能会降低谷氨酰胺合成所需的BCAA水平。本研究的目的是评估胃肠道癌症手术后患者使用BCAA或富含谷氨酰胺的TPN的必要性。
我们的目的是研究接受结直肠癌、小肠癌或胰腺癌手术且术后接受或未接受TPN的患者血浆BCAA和谷氨酰胺浓度的变化。通过离子交换色谱法测定血浆游离氨基酸浓度。
对照组手术导致术后缬氨酸、异亮氨酸和亮氨酸浓度降低。在接受TPN的患者中，这种降低从术后第三天开始受到抑制，但结直肠癌组的缬氨酸和亮氨酸除外。在对照组和接受TPN的患者组中，谷氨酰胺浓度在手术后降低，随后从术后第三天开始升高。
胃肠道癌症患者手术导致BCAA浓度降低。标准TPN对胰腺癌和小肠癌患者的BCAA水平有有益影响。对于结直肠癌患者，这种TPN应添加亮氨酸和缬氨酸。
