Askanazi J, Carpentier Y A, Michelsen C B, Elwyn D H, Furst P, Kantrowitz L R, Gump F E, Kinney J M
Ann Surg. 1980 Jul;192(1):78-85. doi: 10.1097/00000658-198007000-00014.
The present study was undertaken to determine intracellular amino acid patterns in patients with multiple trauma, whether or not complicated by sepsis and during convalescence. A percutaneous muscle biopsy was performed three to four days following major accidental injury in ten patients and analyzed for muscle free amino acids. Venous blood was drawn at the time of the biopsy and analyzed for plasma free amino acids. Five patients developed sepsis and a repeat biopsy was performed on days 8 to 11. In five of the patients a biopsy was performed during the late convalescent period (anabolic phase). A marked depletion of nonessential amino acids in muscle occurred in both injury and sepsis due to a decrease (50%) in glutamine, which was equally marked in both states. The essential amino acids in muscle increased in injury. During sepsis, a further increase was observed with a return toward normal in the convalescent period. In injury, the most marked rise was in the branched-chain amino acids, phenylalanine, tryosine and methionine. With sepsis, a further rise in muscle branched-chain amino acids, phenylalanine and tryosine occurred, while plasma levels remain unchanged. During convalescence, muscle glutamine, arginine, histidine and plasma branched-chain amino acids were below normal, whereas muscle phenylalanine and methionine were elevated. The muscle free amino acid pattern observed after major trauma was essentially the same as earlier described following elective operation. This suggests a common response of intracellular amino acids irrespective of the degree of injury, and may indicate that the pump settings which regulate amino acid transport follow the "all or none" rule. The high intracellular levels of branched-chain amino acids in sepsis suggest that the energy deficit of this state is due to an impairment of substrate use rather than intracellular availability. The high concentrations of the aromatic amino acids and methionine may be due to altered liver function. During the late convalescent period (anabolic phase) the low levels of certain key amino acids suggests inadequate nutrition. The difficulties in nourishing the injured or septic patient are well recognized. The period following these catabolic states may be an important period for the application of an optimal, aggressive nutritional regimen.
本研究旨在确定多发伤患者（无论是否并发脓毒症）及恢复期患者的细胞内氨基酸模式。在10例患者遭受重大意外伤害3至4天后进行经皮肌肉活检，并分析肌肉游离氨基酸。在活检时采集静脉血并分析血浆游离氨基酸。5例患者发生脓毒症，并在第8至11天进行了重复活检。5例患者在恢复期后期（合成代谢期）进行了活检。由于谷氨酰胺减少（50%），损伤和脓毒症时肌肉中的非必需氨基酸均显著减少，在两种状态下减少程度相同。损伤时肌肉中的必需氨基酸增加。脓毒症期间，进一步增加，恢复期恢复正常。损伤时，最显著升高的是支链氨基酸、苯丙氨酸、酪氨酸和蛋氨酸。脓毒症时，肌肉支链氨基酸、苯丙氨酸和酪氨酸进一步升高，而血浆水平保持不变。恢复期时，肌肉谷氨酰胺、精氨酸、组氨酸和血浆支链氨基酸低于正常水平，而肌肉苯丙氨酸和蛋氨酸升高。重大创伤后观察到的肌肉游离氨基酸模式与择期手术后早期描述的基本相同。这表明无论损伤程度如何，细胞内氨基酸都有共同反应，可能表明调节氨基酸转运的泵设置遵循“全或无”规则。脓毒症时细胞内支链氨基酸水平高表明该状态下的能量不足是由于底物利用受损而非细胞内可用性。芳香族氨基酸和蛋氨酸的高浓度可能是由于肝功能改变。在恢复期后期（合成代谢期），某些关键氨基酸水平低表明营养不足。营养受损或脓毒症患者的营养困难是众所周知的。这些分解代谢状态后的时期可能是应用最佳、积极营养方案的重要时期。
