Frankenfield D C, Badellino M M, Reynolds H N, Wiles C E, Siegel J H, Goodarzi S
Department of Nutrition, Maryland Institute for Emergency Medical Services Systems, Baltimore.
JPEN J Parenter Enteral Nutr. 1993 Nov-Dec;17(6):551-61. doi: 10.1177/0148607193017006551.
Amino acid loss, plasma concentration, and the relationship between amino acid intake and balance during continuous hemodiafiltration (CHD) were investigated in a prospective, nonrandomized study of trauma patients exhibiting the systemic inflammatory response with acute renal failure. Data were compared with those from a group of similar patients who had maintained renal function (control). Both groups received similar amounts of nonprotein calories (3015 +/- 753 nonprotein calories per day in the control group vs 3077 +/- 1018 nonprotein calories per day in the CHD group) and amino acids (2.24 +/- 0.36 g/kg per day in the control group vs 2.19 +/- 0.48 g/kg per day in the CHD group) via the parenteral route. Amino acid solutions were either 19% or 45% branched-chain amino acid enriched. Studies were performed every 12 hours for a maximum of 6 days. Amino acid loss was 2.5 +/- 2.3 g/12 h in the control group vs 6.6 +/- 2.4 g/12 h in the CHD group (p < .0001). Increasing the dialysate rate from 15 to 30 mL/min increased amino acid loss from 5.7 +/- 1.7 to 7.9 +/- 2.6 g/12 h (p < .0001). Amino acid loss was unrelated to amino acid intake but was directly related to plasma amino acid concentration, CHD effluent volume, and the efficiency of filtration as measured by the ratio of filtered urea nitrogen to blood urea nitrogen (R2 = .69). A linear relationship was found between amino acid intake and balance (R2 = .991). The patterns of plasma amino acid concentrations were consistent with metabolic changes wrought by a combination of sepsis and multiple organ dysfunction and type of amino acid intake but seemed unaffected by increased amino acid loss in CHD effluent. Amino acid losses were 2 to 3 times greater from CHD than from normal kidney. However, CHD amino acid losses may not be clinically significant unless amino acid intake is restricted to levels used typically in traditional hemodialysis.
在一项针对表现出全身炎症反应并伴有急性肾衰竭的创伤患者的前瞻性、非随机研究中，对持续血液透析滤过（CHD）期间的氨基酸损失、血浆浓度以及氨基酸摄入量与平衡之间的关系进行了研究。将数据与一组肾功能正常的类似患者（对照组）的数据进行比较。两组均通过肠外途径接受相似量的非蛋白质热量（对照组为每天3015±753非蛋白质热量，CHD组为每天3077±1018非蛋白质热量）和氨基酸（对照组为每天2.24±0.36 g/kg，CHD组为每天2.19±0.48 g/kg）。氨基酸溶液富含19%或45%的支链氨基酸。每12小时进行一次研究，最长持续6天。对照组的氨基酸损失为2.5±2.3 g/12小时，CHD组为6.6±2.4 g/12小时（p<0.0001）。将透析液流速从15 mL/分钟提高到30 mL/分钟，氨基酸损失从5.7±1.7 g/12小时增加到7.9±2.6 g/12小时（p<0.0001）。氨基酸损失与氨基酸摄入量无关，但与血浆氨基酸浓度、CHD流出液量以及通过滤过尿素氮与血尿素氮之比衡量的滤过效率直接相关（R2 = 0.69）。发现氨基酸摄入量与平衡之间存在线性关系（R2 = 0.991）。血浆氨基酸浓度模式与脓毒症和多器官功能障碍以及氨基酸摄入类型共同造成的代谢变化一致，但似乎不受CHD流出液中氨基酸损失增加的影响。CHD导致的氨基酸损失比正常肾脏大2至3倍。然而，除非将氨基酸摄入量限制在传统血液透析通常使用的水平，否则CHD的氨基酸损失在临床上可能并不显著。
