Smolle K H, Kaufmann P, Holzer H, Druml W
Medical Department, University of Graz, Austria.
Nephrol Dial Transplant. 1995;10(8):1411-6.
Malnutrition is frequently encountered in patients on regular haemodialysis therapy and presents an important determinant of morbidity and mortality. Usual therapeutic approaches to alleviate malnutrition have been unsuccessful. The objective of this study was to assess the impact of intradialytic parenteral nutrition (IDPN) with amino acids (in combination with a glucose-containing dialysate) on nutritional parameters and immunocompetence in patients on regular haemodialysis treatment.
Effects of IDPN were evaluated in 16 malnourished patients. After a run-in period of 4 weeks (to define stable baseline conditions) 0.8 g amino acids/kg bodyweight using a novel amino-acid solution (adapted to metabolic alteration of uraemia and including the dipeptide glycyl-tyrosine as tyrosine source) was infused thrice weekly during each haemodialysis session for 16 weeks.
Intradialytic amino-acid infusion was well tolerated and the dipeptide was rapidly utilized with only traces being detectable in plasma after dialysis. Visceral protein synthesis was improved, serum albumin, prealbumin, and cholinesterase increased during IDPN (P < 0.05). As indicators of augmented immunocompetence skin test reactivity against multiple antigens was improved (P < 0.02) and total lymphocyte count was raised (P < 0.05). Plasma amino acid pattern did not deteriorate but failed to normalize during IDPN and phenylalanine/tyrosine ratio remained stable. Anthropometric measurements and eating behaviour as assessed by dietary records were not altered during IDPN.
Even using a simple and limited intradialytic nutritional support with amino acids can improve visceral protein status and stimulate immunocompetence in malnourished patients on regular haemodialysis therapy.
营养不良在接受常规血液透析治疗的患者中经常出现，是发病率和死亡率的重要决定因素。缓解营养不良的常用治疗方法均未成功。本研究的目的是评估含氨基酸的透析中胃肠外营养（IDPN）（与含葡萄糖的透析液联合使用）对接受常规血液透析治疗患者营养参数和免疫能力的影响。
对16例营养不良患者评估IDPN的效果。经过4周的导入期（以确定稳定的基线状况）后，在每次血液透析过程中，每周三次输注0.8g氨基酸/kg体重，使用一种新型氨基酸溶液（适应尿毒症的代谢改变，包括二肽甘氨酰 - 酪氨酸作为酪氨酸来源），共16周。
透析中输注氨基酸耐受性良好，二肽被迅速利用，透析后血浆中仅可检测到微量。内脏蛋白合成得到改善，IDPN期间血清白蛋白、前白蛋白和胆碱酯酶增加（P<0.05）。作为免疫能力增强指标，对多种抗原的皮肤试验反应性得到改善（P<0.02），总淋巴细胞计数升高（P<0.05）。血浆氨基酸模式没有恶化，但在IDPN期间未能恢复正常，苯丙氨酸/酪氨酸比值保持稳定。通过饮食记录评估的人体测量和饮食行为在IDPN期间未改变。
即使使用简单且有限的透析中氨基酸营养支持，也可改善接受常规血液透析治疗的营养不良患者的内脏蛋白状况并刺激免疫能力。
