Freund H, Atamian S, Holroyde J, Fischer J E
Ann Surg. 1979 Nov;190(5):571-6. doi: 10.1097/00000658-197911000-00003.
Sepsis is a major catabolic insult resulting in a peripheral energy deficit which is made up in part by increased breakdown of lean body mass and oxidation of amino acids, principally the branched chain amino acids. The prognosis in any given case of sepsis is difficult to predict, but should theoretically be related to the degree of disturbance in peripheral energy deficit, which may in turn, be related to plasma amino acid pattern. In order to study whether this hypothesis was correct, plasma amino acids and some of their metabolic byproducts, the beta-hydroxyphenylethanolamines, were studied in 25 septic patients, and were used as discriminant variables in a series of computer performed discriminant analyses and multiple regressions. The two functions tested were the degree of metabolic septic encephalopathy as a determinant of the severity of sepsis and the final outcome in the septic patient. Plasma amino acid patterns exhibited elevated levels of the aromatic and sulfur containing amino acids, phenylalanine, tryosine, tryptophan, methionine, cysteine, and taurine, normal concentrations of alanine, and low normal concentrations of the branched chain amino acids, valine, leucine and isoleucine. Arginine levels, as previously noted, were very low. Patients not surviving the septic episode exhibited higher concentrations of aromatic and sulfur containing amino acids, while patients surviving sepsis had higher concentrations of the branched chain amino acids and arginine. When the degree of encephalopathy as a determinant of the severity of sepsis and step wise discriminant analysis with multiple crescent techniques were used, the best discriminant function between patients with and without encephalopathy was found to result from the interaction of cysteine, methionine, phenylalanine, isoleucine, leucine, and valine. These amino acids gave a correct classification in 82% of patients with no encephalopathy, and 80% of patients with septic encephalopathy. When the same amino acids were used for the discriminant analysis for patients dying of sepsis and patients surviving, the best discriminant function was achieved by using plasma concentrations of alanine, cysteine, methionine, isoleucine, arginine, tyrosine and phenylalanine resulting in 91% of the nonsurvivors, and 79% of the survivors correctly classified. The results suggest a close and significant relationship between the deranged energy metabolism and muscle protein breakdown in sepsis, and the outcome. This further suggests a central role for certain amino acids in perhaps predicting the severity of sepsis and its outcome.
脓毒症是一种严重的分解代谢损伤，会导致外周能量缺乏，部分原因是瘦体重分解增加以及氨基酸氧化，主要是支链氨基酸的氧化。任何一例脓毒症的预后都难以预测，但理论上应与外周能量缺乏的紊乱程度相关，而外周能量缺乏的紊乱程度反过来可能与血浆氨基酸模式有关。为了研究这一假设是否正确，对25例脓毒症患者的血浆氨基酸及其一些代谢副产物β-羟基苯乙醇胺进行了研究，并将其用作一系列计算机判别分析和多元回归中的判别变量。所测试的两个功能是代谢性脓毒症脑病的程度作为脓毒症严重程度的决定因素以及脓毒症患者的最终结局。血浆氨基酸模式显示含芳香族和含硫氨基酸、苯丙氨酸、酪氨酸、色氨酸、蛋氨酸、半胱氨酸和牛磺酸水平升高，丙氨酸浓度正常，支链氨基酸缬氨酸、亮氨酸和异亮氨酸浓度略低于正常。如前所述，精氨酸水平非常低。脓毒症发作未存活的患者表现出较高浓度的含芳香族和含硫氨基酸，而脓毒症存活患者的支链氨基酸和精氨酸浓度较高。当使用脑病程度作为脓毒症严重程度的决定因素以及采用多重新月技术进行逐步判别分析时，发现无脑病患者和有脑病患者之间的最佳判别功能来自半胱氨酸、蛋氨酸、苯丙氨酸、异亮氨酸、亮氨酸和缬氨酸的相互作用。这些氨基酸对82%的无脑病患者和80%的脓毒症脑病患者进行了正确分类。当将相同的氨基酸用于脓毒症死亡患者和存活患者的判别分析时，通过使用血浆中丙氨酸、半胱氨酸、蛋氨酸、异亮氨酸、精氨酸、酪氨酸和苯丙氨酸的浓度实现了最佳判别功能，91%的非存活者和79%的存活者被正确分类。结果表明脓毒症中能量代谢紊乱与肌肉蛋白分解之间以及与结局之间存在密切且显著的关系。这进一步表明某些氨基酸在预测脓毒症严重程度及其结局方面可能起着核心作用。
