Rich A J, Wright P D
JPEN J Parenter Enteral Nutr. 1979 Sep-Oct;3(5):350-4. doi: 10.1177/014860717900300506.
Hormonal and substrate profiles and urinary nitrogen and urea excretion were measured in 78 underweight patients admitted for surgical investigation, who were placed into either a normo- or a hyperketonemic group, depending upon their levels of acetoacetate and beta-hydroxybutyrate. The two groups were otherwise similar in terms of weight loss, arm muscle circumference, triceps skinfold thickness, and serum protein levels. Before surgery only one-quarter of them were hyperketonemic displaying mean glucose, insulin, and glucagon levels characteristic of starvation-adaption, and excreted significantly less urinary nitrogen than in normoketonemic group. Those patients who underwent surgery tended to retain their presurgery hormonal and substrate profile. The normoketonemic group excreted significantly greater amounts of urinary nitrogen, depleted body protein to a greater extent as evidenced by larger changes in arm muscle circumference and serum protein levels, and mortality was greater. Interference with insulin-glucagon balance by sepsis and disease is suggested as a possible explanation for the failure of three-quarters of the patients to become starvation-adapted. The implications of this finding on the parenteral feeding of undernourished patients are discussed.
对78名因外科检查入院的体重过轻患者进行了激素和底物水平以及尿氮和尿素排泄量的测量。根据乙酰乙酸和β-羟基丁酸水平，将这些患者分为正常酮血症组或高酮血症组。两组在体重减轻、上臂肌肉周长、肱三头肌皮褶厚度和血清蛋白水平方面其他情况相似。手术前，只有四分之一的患者处于高酮血症状态，其血糖、胰岛素和胰高血糖素水平显示出饥饿适应的特征，尿氮排泄量明显低于正常酮血症组。接受手术的患者倾向于保持术前的激素和底物水平。正常酮血症组尿氮排泄量明显更多，上臂肌肉周长和血清蛋白水平变化更大，表明身体蛋白质消耗程度更大，且死亡率更高。脓毒症和疾病对胰岛素-胰高血糖素平衡的干扰被认为是四分之三的患者未能适应饥饿状态的一个可能解释。本文讨论了这一发现对营养不良患者肠外营养的意义。
