Piraino A J, Firpo J J, Powers D V
JPEN J Parenter Enteral Nutr. 1981 Nov-Dec;5(6):463-77. doi: 10.1177/0148607181005006463.
Plasma concentrations of 25 essential (EAA) and nonessential (NEAA) amino acids were measured pre- and postdialysis in 46 chronic hemodialysis therapy (CDT) patients. Sixteen of these patients with prior weight loss of 14.5 +/- 2.37 pounds in 24 months were administered a GAA solution (EAA + NEAA + glucose) for 20 weeks during each dialysis. Eight of these patients (group 1) responded with improved appetite and weight gain; the remaining eight patients (group 2) with clinically advanced metabolic bone disease continued to lose weight. Five other patients (group 14), biochemically similar to group 1 but with shorter prior dialysis experience, who received EAA (plus glucose) hyperalimentation (including oral I-histidine), experienced weight gain similar to group 1 but displayed significantly different plasma aminograms indicating a deficit of NEAA. When EAA and glucose hyperalimentation was administered without histidine (1 patient) no weight gain occurred and aminograms differed significantly from other groups. Plasma aminograms of 25 weight-stable, nonhyperalimented CDT patients were obtained for comparison. Results indicate GAA hyperalimentation can promote weight gain in catabolic CDT patients with inadequate prior nutritional intake (as in groups 1 and 14) but cannot reverse weight loss when the primary clinical setting is advanced metabolic bone disease and myopathy due to hyperparathyroidism (group 2). Hyperalimentation with glucose and an amino acid solution specifically tailored to the needs of CDT patients may improve results. Plasma phosphoethanolamine levels, normal for weight-stable and elevated in catabolic CDT patients, suggest a possible role for phosphoethanolamine as a marker for catabolism.
对46例慢性血液透析治疗（CDT）患者在透析前后测量了25种必需氨基酸（EAA）和非必需氨基酸（NEAA）的血浆浓度。其中16例在24个月内体重减轻了14.5±2.37磅的患者，在每次透析期间接受了20周的GAA溶液（EAA+NEAA+葡萄糖）治疗。这些患者中有8例（第1组）食欲改善、体重增加；其余8例患有临床晚期代谢性骨病的患者继续体重减轻。另外5例患者（第14组），其生化指标与第1组相似，但透析经验较短，接受了EAA（加葡萄糖）高营养治疗（包括口服L-组氨酸），体重增加情况与第1组相似，但血浆氨基酸谱显示出显著差异，表明存在非必需氨基酸缺乏。当在无组氨酸的情况下给予EAA和葡萄糖高营养治疗时（1例患者），未出现体重增加，且氨基酸谱与其他组有显著差异。获取了25例体重稳定、未接受高营养治疗的CDT患者的血浆氨基酸谱用于比较。结果表明，GAA高营养治疗可促进营养摄入不足的分解代谢型CDT患者体重增加（如第1组和第14组），但当主要临床情况为晚期代谢性骨病和甲状旁腺功能亢进导致的肌病时（第2组），无法逆转体重减轻。使用专门根据CDT患者需求定制的葡萄糖和氨基酸溶液进行高营养治疗可能会改善结果。血浆磷酸乙醇胺水平在体重稳定的患者中正常，在分解代谢型CDT患者中升高，提示磷酸乙醇胺可能作为分解代谢的标志物发挥作用。
