Schaeffer G, Heinze V, Jontofsohn R, Katz N, Rippich T h, Schäfer B, Südhoff A, Zimmermann W, Kluthe R
Clin Nephrol. 1975 Jun;3(6):228-33.
In 40 unselected RDT patients (20 center and 20 home dialysis patients) the intake of nutrients was measured using the precise weighing method of Wirths [1969]. The protein intake was found to be 0.97 plus or minus 0.19 g/kg predialysis body weight, the calorie intake 32.3 plus or minus 6.4 cal/kg. Two thirds (0.65 plus or minus 0.15 g/kg) of the protein consisted of high biological value protein. Despite the fact that according to current recommendations the protein intake should have been adequate, signs of protein malnutrition were found. The mean serum concentrations of total protein, transferrin and valine and the ratio of essential amino acids to nonessential amino acids (EAA/NEAA) were significantly lower than in normal subjects and the glycine level was elevated. Histidine levels were normal indicating that the histidine intake measured at 1.75 plus or minus 0.47 g/day appeared adequate under these conditions. Phenylalanine levels were elevated indicating a blocking of 4-hydroxylase leading to low tyrosine levels. A possible reason for these findings may be that the protein requirements of the RDT patient over a long period of time are higher than those found experimentally in short term studies. An inadequate calorie intake could not be excluded. Additionally a dialysis dependent pathologic variation of the daily intake of nutrients may be responsible for the disturbed nutritional status. In connection with this, three distinct types of intake variation can be described: A stable type in which the variation in the daily protein and calorie intake does not differ by more than 20% from a daily mean value, an unstable type I with significantly lower intake on the day of dialysis and an unstable type II with a significantly higher intake on the day of dialysis. Signs of protein malnutrition occurred significantly more frequently in the unstable groups.
在40例未经挑选的居家透析患者（20例中心透析患者和20例居家透析患者）中，采用维尔特斯[1969年]的精确称重法测量营养物质摄入量。发现蛋白质摄入量为0.97±0.19克/透析前体重千克，热量摄入量为32.3±6.4千卡/千克。三分之二（0.65±0.15克/千克）的蛋白质为高生物价蛋白质。尽管根据当前建议蛋白质摄入量应该充足，但仍发现了蛋白质营养不良的迹象。总蛋白、转铁蛋白和缬氨酸的平均血清浓度以及必需氨基酸与非必需氨基酸的比例（EAA/NEAA）显著低于正常受试者，而甘氨酸水平升高。组氨酸水平正常，表明在这些条件下，测得的组氨酸摄入量为1.75±0.47克/天似乎充足。苯丙氨酸水平升高，表明4-羟化酶受阻导致酪氨酸水平降低。这些发现的一个可能原因可能是，居家透析患者长期的蛋白质需求高于短期实验研究中的发现。不能排除热量摄入不足的情况。此外，依赖透析的每日营养摄入量的病理变化可能是营养状况紊乱的原因。与此相关，可以描述三种不同类型的摄入量变化：一种稳定类型，其中每日蛋白质和热量摄入量的变化与每日平均值相差不超过20%；一种不稳定类型I，透析日摄入量显著降低；一种不稳定类型II，透析日摄入量显著升高。蛋白质营养不良的迹象在不稳定组中出现的频率明显更高。
