Tsujimoto Takae, Shimizu Kentaro, Hata Nobuaki, Takagi Tatsuya, Uejima Etsuko, Ogura Hiroshi, Wasa Masafumi, Shimazu Takeshi
Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University, 1-1-3 Minatojima, Chuo-ku, Kobe, Hyogo, Japan.
Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka, Japan.
Surg Today. 2017 Nov;47(11):1331-1338. doi: 10.1007/s00595-017-1511-0. Epub 2017 Apr 3.
Plasma amino acids are important indicators for understanding human kinetics and amino acid dynamics. We aimed to investigate the association between the plasma glutamine levels and the mortality rates and determine whether plasma glutamine can predict the prognosis of critically ill patients.
The clinical records of adult patients who were admitted to an ICU were retrospectively evaluated to investigate the plasma levels of amino acids, including glutamine.
Two hundred fourteen patients were included in this study (male, 62%; median age, 64 years; range 20-97 years). The patients' diagnoses included sepsis (45%), trauma (14%), cardiovascular disease (9%), fulminant hepatitis (9%), burns (4%), and others (19%). The mortality rates in patients with plasma glutamine <400 nmol/mL (group L; 39%, 28/71) or ≥700 nmol/mL (group H; 50%, 15/30) were significantly higher (p < 0.05 and p < 0.01, respectively) than those in patients with plasma glutamine levels of 400-700 nmol/mL (group M; 21%, 24/113). Among patients with sepsis, the mortality rates of group L (46%) and group H (67%) were significantly higher (p < 0.05 or p < 0.01, respectively) in comparison with group M (26%).
Both lower and higher plasma glutamine levels were risk factors for mortality in critically ill patients.
血浆氨基酸是了解人体动力学和氨基酸动态变化的重要指标。我们旨在研究血浆谷氨酰胺水平与死亡率之间的关联，并确定血浆谷氨酰胺是否能预测危重症患者的预后。
对入住重症监护病房（ICU）的成年患者的临床记录进行回顾性评估，以研究包括谷氨酰胺在内的血浆氨基酸水平。
本研究纳入了214例患者（男性占62%；中位年龄64岁；范围20 - 97岁）。患者的诊断包括败血症（45%）、创伤（14%）、心血管疾病（9%）、暴发性肝炎（9%）、烧伤（4%）以及其他疾病（19%）。血浆谷氨酰胺水平<400 nmol/mL的患者（L组；39%，28/71）或≥700 nmol/mL的患者（H组；50%，15/30）的死亡率显著高于血浆谷氨酰胺水平为400 - 700 nmol/mL的患者（M组；21%，24/113）（分别为p < 0.05和p < 0.01）。在败血症患者中，L组（46%）和H组（67%）的死亡率与M组（26%）相比显著更高（分别为p < 0.05或p < 0.01）。
血浆谷氨酰胺水平过低和过高均是危重症患者死亡的危险因素。
