Patel Jayshil J, McClain Craig J, Sarav Menaka, Hamilton-Reeves Jill, Hurt Ryan T
1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
2 Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Pharmacology and Toxicology, University of Louisville, and Robley Rex VA Medical Center, Louisville, Kentucky, USA.
Nutr Clin Pract. 2017 Apr;32(1_suppl):101S-111S. doi: 10.1177/0884533616687501. Epub 2017 Feb 16.
Diseases leading to critical illness induce proteolysis resulting in muscle wasting and negative nitrogen balance. Muscle wasting has been associated with poor intensive care unit (ICU)-related outcomes, including an increased risk for mortality. Acute kidney injury (AKI) represents a common organ dysfunction associated with ICU-related disorders, such as sepsis, trauma, and respiratory failure. AKI and renal replacement therapy lead to amino acid loss. Decompensated liver cirrhosis (DLC) and acute liver failure (ALF) represent more severe forms of liver dysfunction leading to ICU admission. DLC and ALF are associated with proteolysis and amino acid loss. AKI, DLC, and ALF uniquely contribute to negative nitrogen balance. The purpose of this review is to outline proteolysis associated with critical illness; define specific protein abnormalities in AKI, DLC, and ALF; define protein requirements in AKI, DLC, and ALF; and discuss barriers associated with optimal protein supplementation in these disorders.
导致危重症的疾病会引发蛋白水解，导致肌肉萎缩和负氮平衡。肌肉萎缩与重症监护病房（ICU）相关的不良预后有关，包括死亡风险增加。急性肾损伤（AKI）是一种与ICU相关疾病（如脓毒症、创伤和呼吸衰竭）相关的常见器官功能障碍。AKI和肾脏替代治疗会导致氨基酸流失。失代偿性肝硬化（DLC）和急性肝衰竭（ALF）是导致入住ICU的更严重的肝功能障碍形式。DLC和ALF与蛋白水解和氨基酸流失有关。AKI、DLC和ALF对负氮平衡有独特的影响。本综述的目的是概述与危重症相关的蛋白水解；定义AKI、DLC和ALF中特定的蛋白质异常；确定AKI、DLC和ALF中的蛋白质需求；并讨论这些疾病中与最佳蛋白质补充相关的障碍。
