Brandl M, Tonak J, Rottler H
Aust N Z J Surg. 1982 Aug;52(4):350-3. doi: 10.1111/j.1445-2197.1982.tb06007.x.
Urea production rate and cellular immune reactivity measured by skin stamp test were used to determine the extent of protein catabolism in 30 surgical patients with histologically diagnosed gastrointestinal carcinoma. All patients received high-caloric total parenteral nutrition (TPN) preoperatively. In those patients with an urea production rate of less than 15 g/day (according to definition of non-catabolic state) TPN was discontinued and the operation performed immediately, whereas the remaining 13 patients with an urea production rate exceeding 15 g/day (according to definition a catabolic state) were given TPN a total of 10 days prior to operation. Nine of the 13 patients could be converted from a catabolic to a non-catabolic state. Only one of these patients died, whereas of the remaining 4 patients who - according to the definition - remained in a catabolic state, two died. The course of nutrition positively influenced the serum levels of IgG, IgA and IgM. The skin stamp test was positive in only three of the 13 patients. Obviously, a positive skin test reaction occurred only in those patients who could be returned to a non-catabolic state during the course of TPN. By means of preoperative TPN catabolic patients can be converted into a non-catabolic state which is associated with a reduction in morbidity and mortality. Moreover, high caloric parenteral nutrition rich in amino acids seem to improve the prognosis for patients with negative skin test reactivity.
通过皮肤划痕试验测定尿素生成率和细胞免疫反应性，以确定30例经组织学诊断为胃肠道癌的外科患者的蛋白质分解代谢程度。所有患者术前均接受高热量全胃肠外营养（TPN）。对于尿素生成率低于15克/天的患者（根据非分解代谢状态的定义），停止TPN并立即进行手术，而其余13例尿素生成率超过15克/天的患者（根据定义为分解代谢状态）在手术前共接受10天的TPN。13例患者中有9例可从分解代谢状态转变为非分解代谢状态。这些患者中只有1例死亡，而其余4例根据定义仍处于分解代谢状态的患者中有2例死亡。营养过程对IgG、IgA和IgM的血清水平有积极影响。13例患者中只有3例皮肤划痕试验呈阳性。显然，只有那些在TPN过程中可恢复到非分解代谢状态的患者才会出现阳性皮肤试验反应。通过术前TPN，分解代谢患者可转变为非分解代谢状态，这与发病率和死亡率的降低相关。此外，富含氨基酸的高热量胃肠外营养似乎可改善皮肤试验反应阴性患者的预后。
