Chen Yu, Ren Jianan, Qin Xiaodong, Li Guanwei, Zhou Bo, Gu Guosheng, Hong Zhiwu, Aa JiYe, Li Jieshou
Department of Surgery, Jinling Hospital, Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu 210002, China ; Minimally Invasive Department of General Surgery, Fushun Central Hospital, Fushun, Liaoning 113006, China.
Department of Surgery, Jinling Hospital, Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu 210002, China.
Biomed Res Int. 2015;2015:917674. doi: 10.1155/2015/917674. Epub 2015 Jan 14.
The systemic inflammatory response syndrome (SIRS) is characterized by a hypercatabolic state induced by inflammatory mediators. Continuous venovenous hemofiltration (CVVH) stabilizes the internal environment but also aggravates loss of amino acids. The effect of CVVH on protein dynamics is largely unknown. We adopted the stable isotopic tracer technology to investigate how CVVH changed serum albumin metabolism.
Twenty SIRS patients were randomized into low- (2000 mL/h) and high- (4000 mL/h) volume CVVH groups according to the rate of replacement fluid. Eight patients with abdominal infection matched for age, sex, and laboratory index served as controls. Consecutive arterial blood samples were drawn during a primed-constant infusion of two stable isotopes to determine the albumin fractional synthesis rate (FSR) and fractional breakdown rate (FBR).
Before treatment, there was no significant difference of FSR and FBR among 3 groups. After CVVH, the albumin FSR in high- and low-volume groups was 7.75±1.08% and 7.30±0.89%, respectively, both higher than in the control (5.83±0.94%). There was no significant difference in albumin FBR after treatment.
Protein dynamic indicators could reflect protein synthesis and breakdown state directly and effectively. CVVH increased albumin synthesis, while the breakdown rate remained at a high level independently of the CVVH rate.
全身炎症反应综合征（SIRS）的特征是由炎症介质诱导的高分解代谢状态。持续静静脉血液滤过（CVVH）可稳定内环境，但也会加重氨基酸的丢失。CVVH对蛋白质动力学的影响在很大程度上尚不清楚。我们采用稳定同位素示踪技术来研究CVVH如何改变血清白蛋白代谢。
根据置换液速率将20例SIRS患者随机分为低容量（2000 mL/h）和高容量（4000 mL/h）CVVH组。选取8例年龄、性别和实验室指标相匹配的腹部感染患者作为对照组。在连续输注两种稳定同位素的起始-持续输注过程中采集连续动脉血样，以测定白蛋白分数合成率（FSR）和分数分解率（FBR）。
治疗前，3组间FSR和FBR无显著差异。CVVH治疗后，高容量组和低容量组的白蛋白FSR分别为7.75±1.08%和7.30±0.89%，均高于对照组（5.83±0.94%）。治疗后白蛋白FBR无显著差异。
蛋白质动力学指标能直接有效地反映蛋白质合成和分解状态。CVVH增加了白蛋白合成，而分解率独立于CVVH速率维持在较高水平。
