Sapir D G, Stewart P M, Walser M, Moreadith C, Moyer E D, Imbembo A L, Rosenshein N B, Munoz S
Lancet. 1983 May 7;1(8332):1010-4. doi: 10.1016/s0140-6736(83)92643-0.
21 patients undergoing major abdominal surgery were randomly assigned to one of three groups. On the day of surgery and for the succeeding 4 days each group received a daily infusion of one of the following: 10 g glucose plus 70 mmol NaHCO3, 70 mmol leucine plus 70 mmol NaHCO3, or 70 mmol of sodium alpha-ketoisocaproate (KIC). No other calories were given. Leucine infusions had no significant effect on nitrogen (N) balance, 3-methylhistidine excretion, or plasma concentrations of pre-albumin or retinol-binding protein, but they increased blood acetoacetate concentration (p = 0.004). N balance was less negative (p = 0.002) and 3-methylhistidine excretion lower (p = 0.002) in the group receiving KIC than in those receiving glucose. Blood ketone bodies, plasma prealbumin, and plasma retinol-binding protein concentrations at the end of the study were significantly higher in the KIC group than in the others. These N-sparing effects of KIC may be related to the heightened ketosis that followed its administration, to suppression of protein degradation, or to an effect on liver protein turnover. KIC alone in small doses diminishes N wastage in postoperative but under the same conditions leucine does not.
21名接受腹部大手术的患者被随机分为三组。在手术当天及随后4天，每组患者每天接受以下一种溶液的输注：10克葡萄糖加70毫摩尔碳酸氢钠、70毫摩尔亮氨酸加70毫摩尔碳酸氢钠、或70毫摩尔α-酮异己酸（KIC）。未给予其他热量。输注亮氨酸对氮（N）平衡、3-甲基组氨酸排泄、前白蛋白或视黄醇结合蛋白的血浆浓度均无显著影响，但会增加血液中乙酰乙酸浓度（p = 0.004）。与接受葡萄糖的组相比，接受KIC的组氮平衡的负值更小（p = 0.002），3-甲基组氨酸排泄更低（p = 0.002）。研究结束时，KIC组的血酮体、血浆前白蛋白和血浆视黄醇结合蛋白浓度显著高于其他组。KIC的这些节省氮的作用可能与其给药后酮血症加剧、蛋白质降解受抑制或对肝脏蛋白质周转的影响有关。小剂量单独使用KIC可减少术后氮的浪费，但在相同条件下亮氨酸则无此作用。
