Su Longxiang, Li Hua, Xie Aimei, Liu Dan, Rao Weiqiao, Lan Liping, Li Xuan, Li Fang, Xiao Kun, Wang Huijuan, Yan Peng, Li Xin, Xie Lixin
Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China; Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Clinical Metabolomics Platform, BGI Health, BGI Shenzhen, Shenzhen, China.
PLoS One. 2015 Apr 7;10(4):e0121933. doi: 10.1371/journal.pone.0121933. eCollection 2015.
The goal of this work was to explore the dynamic concentration profiles of 42 amino acids and the significance of these profiles in relation to sepsis, with the aim of providing guidance for clinical therapies.
Thirty-five critically ill patients with sepsis were included. These patients were further divided into sepsis (12 cases) and severe sepsis (23 cases) groups or survivor (20 cases) and non-survivor (15 cases) groups. Serum samples from the patients were collected on days 1, 3, 5, 7, 10, and 14 following intensive care unit (ICU) admission, and the serum concentrations of 42 amino acids were measured.
The metabolic spectrum of the amino acids changed dramatically in patients with sepsis. As the disease progressed further or with poor prognosis, the levels of the different amino acids gradually increased, decreased, or fluctuated over time. The concentrations of sulfur-containing amino acids (SAAs), especially taurine, decreased significantly as the severity of sepsis worsened or with poor prognosis of the patient. The serum concentrations of SAAs, especially taurine, exhibited weak negative correlations with the Sequential Organ Failure Assessment (SOFA) (r=-0.319) and Acute Physiology and Chronic Health Evaluation (APACHE) II (r=-0.325) scores. The areas under the receiver operating characteristic curves of cystine, taurine, and SAA levels and the SOFA and APACHE II scores, which denoted disease prognosis, were 0.623, 0.674, 0.678, 0.86, and 0.857, respectively.
Critically ill patients with disorders of amino acid metabolism, especially of SAAs such as cystine and taurine, may provide an indicator of the need for the nutritional support of sepsis in the clinic.
ClinicalTrial.gov identifier NCT01818830.
本研究旨在探究42种氨基酸的动态浓度分布情况及其与脓毒症的关系，为临床治疗提供指导。
纳入35例脓毒症重症患者。这些患者进一步分为脓毒症组（12例）和严重脓毒症组（23例），或生存组（20例）和非生存组（15例）。在重症监护病房（ICU）入院后的第1、3、5、7、10和14天采集患者的血清样本，并测定42种氨基酸的血清浓度。
脓毒症患者氨基酸的代谢谱发生了显著变化。随着疾病进展或预后不良，不同氨基酸水平随时间逐渐升高、降低或波动。含硫氨基酸（SAA）水平，尤其是牛磺酸，随着脓毒症严重程度的加重或患者预后不良而显著降低。SAA血清浓度，尤其是牛磺酸，与序贯器官衰竭评估（SOFA）评分（r = -0.319）和急性生理与慢性健康状况评估（APACHE）II评分（r = -0.325）呈弱负相关。胱氨酸、牛磺酸和SAA水平以及表示疾病预后的SOFA和APACHE II评分的受试者工作特征曲线下面积分别为0.623、0.674、0.678、0.86和0.857。
氨基酸代谢紊乱的重症患者，尤其是胱氨酸和牛磺酸等SAA代谢紊乱的患者，可能为临床上脓毒症营养支持需求提供指标。
ClinicalTrial.gov标识符NCT01818830。
