Marchesini G, Forlani G, Zoli M, Angiolini A, Scolari M P, Bianchi F B, Pisi E
Dig Dis Sci. 1979 Aug;24(8):594-601. doi: 10.1007/BF01333703.
Alterations in insulin and glucagon levels might account for the plasma amino acid imbalance of cirrhotics. In order to verify this hypothesis we evaluated basal insulin, glucagon, branched-chain amino acids, aromatic amino acids, and free tryptophan in 13 controls and 37 cirrhotics divided on the basis of their mental state; in 4 patients the hormonal and amino acid patterns were sequentially studied during various stages of encephalopathy. Glucagon is high in cirrhotics and progressively increases with the worsening of the mental state. Free tryptophan and aromatic amino acids show a similar behavior and significantly correlate with glucagon levels (r = 0.67 and r = 0.81, respectively). On the other hand insulin levels, which are high in cirrhotics without encephalopathy, fall in the presence of deep coma. Insulin did not correlate with any of the plasma amino acids considered. Our data suggest that the catabolic state associated with increased glucagon levels may account for some of the alterations in the plasma amino acid profiles of cirrhotics. Portal-systemic shunting does not seem to be the common cause of both hyperglucagonemia and hyperaminoacidemia. Decreased branched-chain amino acid levels may be related to factors different from those involved in the alterations of carbohydrate homeostasis.
胰岛素和胰高血糖素水平的改变可能是肝硬化患者血浆氨基酸失衡的原因。为了验证这一假设，我们评估了13名对照者和37名根据精神状态分组的肝硬化患者的基础胰岛素、胰高血糖素、支链氨基酸、芳香族氨基酸和游离色氨酸水平；对4名患者在肝性脑病的不同阶段对激素和氨基酸模式进行了连续研究。肝硬化患者的胰高血糖素水平较高，且随着精神状态的恶化而逐渐升高。游离色氨酸和芳香族氨基酸表现出相似的变化趋势，且与胰高血糖素水平显著相关（分别为r = 0.67和r = 0.81）。另一方面，在没有肝性脑病的肝硬化患者中胰岛素水平较高，但在深度昏迷时下降。胰岛素与所检测的任何血浆氨基酸均无相关性。我们的数据表明，与胰高血糖素水平升高相关的分解代谢状态可能是肝硬化患者血浆氨基酸谱改变的部分原因。门体分流似乎不是高胰高血糖素血症和高氨基酸血症的共同原因。支链氨基酸水平降低可能与碳水化合物稳态改变所涉及的因素不同。
