Chessex P, Gagne G, Pineault M, Vaucher J, Bisaillon S, Brisson G
Department of Pediatrics, University of Montreal, Quebec, Canada.
J Pediatr. 1989 Dec;115(6):992-7. doi: 10.1016/s0022-3476(89)80756-5.
To evaluate the metabolic and clinical consequences of changing from high-glucose to high-fat regimens during initiation of parenteral nutrition, we performed 22 studies in 11 newborn infants (birth weight (mean +/- SD) 2.54 +/- 0.54 kg, gestational age 37 +/- 3 weeks, postnatal age 8 +/- 3 days) maintained in a constant thermal environment. In a paired design, two isoproteinic (2.4 +/- 0.2 gm/kg/day) and isocaloric (64 +/- 6 kcal/kg/day) regimens differing by source of energy (high glucose vs high lipid) were infused on consecutive days. Environmental and body temperatures were recorded during a 4-hour period, and 24-hour urinary excretions of catecholamines, nitrogen, and C peptide were measured. Despite constant incubator and average skin temperatures, the rectal and interscapular temperatures rose significantly when the high-glucose regimen was changed to a high-lipid regimen. The specific locations of these changes in body temperature suggested brown fat activation. A significant drop in nitrogen retention (63 +/- 9% vs 56 +/- 10%) during the lipid infusion could be further evidence of a metabolic adaptation to the rapid change in energy substrates.
为评估肠外营养起始阶段从高糖方案改为高脂方案的代谢及临床后果，我们对11名新生儿（出生体重（均值±标准差）2.54±0.54kg，胎龄37±3周，生后年龄8±3天）在恒定热环境下进行了22项研究。采用配对设计，连续两日输注两种等蛋白（2.4±0.2g/kg/天）、等热量（64±6kcal/kg/天）但能量来源不同（高糖与高脂）的方案。在4小时内记录环境温度和体温，并测量24小时尿儿茶酚胺、氮和C肽排泄量。尽管暖箱温度和平均皮肤温度恒定，但从高糖方案改为高脂方案时，直肠温度和肩胛间温度显著升高。这些体温变化的具体部位提示棕色脂肪被激活。输注脂质期间氮潴留显著下降（63±9%对56±10%），这可能是对能量底物快速变化的代谢适应的进一步证据。
