Fischer J E, Rosen H M, Ebeid A M, James J H, Keane J M, Soeters P B
Surgery. 1976 Jul;80(1):77-91.
Previous work from this laboratory has suggested that the plasma amino acid pattern, known to be deranged in hepatic encephalopathy, may be related causally. In order to test this hypothesis, 23% dextrose and a special amino acid solution whose components were calculated to normalize the plasma amino acid pattern were infused in 11 patients, eight with chronic cirrhosis and acute exacerbation (Group 1) and three patients with fulminant hepatitis (Group 2), in amounts of up to 120 Gm. of protein equivalent per 24 hours. Plasma amino acids were abnormal but different in both groups. In Group 1 (cirrhosis) changes in plasma amino acid pattern including elevated phenylalanine, tyrosine, glutamate, aspartate, and methionine and decreased valine, leucine, and isoleucine. In Group 2 all amino acids were elevated, with the exception of the branched chains which were normal. Hepatic encephalopathy improved in all patients in Group 1 and in one of three patients in Group 2 following the infusion. The ratio (see article) showed an excellent correlation with a grade of encephalopathy. When this ratio, previously 1.0 in the presence of encephalopathy, returned to the normal value near 3.0 to 3.5, encephalopathy improved. An excellent correlation was obtained between the ratio and the grade of encephalopathy and was dose related as well. The results suggest that different amino acid patterns in hepatic encephalopathy of differing etiologies require treatment modalities which may differ for the two types of encephalopathy. Whereas amino acid infusion appears to be a valuable, efficacious way of providing nutrition in treating hepatic encephalopathy in patients with cirrhosis and acute deterioration and coma, other means of therapy such as plasms "laundering" appear to be necessary in patients with fulminant hepatitis.
该实验室先前的研究表明，已知在肝性脑病中紊乱的血浆氨基酸模式可能存在因果关系。为了验证这一假设，对11例患者输注了23%的葡萄糖和一种特殊氨基酸溶液，其成分经计算可使血浆氨基酸模式正常化，其中8例为慢性肝硬化急性加重患者（第1组），3例为暴发性肝炎患者（第2组），输注量高达每24小时120克蛋白质当量。两组患者的血浆氨基酸均异常，但有所不同。在第1组（肝硬化）中，血浆氨基酸模式发生变化，包括苯丙氨酸、酪氨酸、谷氨酸、天冬氨酸和蛋氨酸升高，缬氨酸、亮氨酸和异亮氨酸降低。在第2组中，除支链氨基酸正常外，所有氨基酸均升高。输注后，第1组所有患者和第2组3例患者中的1例肝性脑病得到改善。该比率（见文章）与肝性脑病分级显示出极好的相关性。当该比率在存在脑病时先前为1.0，恢复到接近3.0至3.5的正常值时，脑病得到改善。该比率与肝性脑病分级之间获得了极好的相关性，并且也与剂量相关。结果表明，不同病因的肝性脑病中不同的氨基酸模式需要不同的治疗方式，这两种类型的脑病可能有所不同。虽然氨基酸输注似乎是为肝硬化急性恶化和昏迷患者治疗肝性脑病提供营养的一种有价值、有效的方法，但对于暴发性肝炎患者，其他治疗手段如血浆“清洗”似乎是必要的。
