Douma C E, de Waart D R, Struijk D G, Krediet R T
Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Clin Nephrol. 1996 May;45(5):295-302.
Amino acid dialysis solution 1.1% (Nutrineal) contains L-arginine, a substrate for nitric oxide (NO) synthesis. NO causes vasodilation in many organs. To investigate effects of the amino acid dialysis solution on peritoneal permeability and perfusion, standard peritoneal permeability analyses were performed in 10 stable CAPD patients; one with Nutrineal and another with glucose dialysate (Dianeal 1.36%). The mass transfer area coefficient (MTAC) of nitrate and cGMP were calculated to study a possible role of NO. The MTAC of CO2 was measured to estimate peritoneal blood flow. The MTAC of CO2 was higher during the 4-hour dwell with the amino acid solution: median 93 ml/min (amino acid solution) vs. 60 ml/min (glucose solution); p < 0.01. This suggests an increased peritoneal blood flow during the administration of amino acids. Also the MTACs of low molecular weight solutes were greater with amino acids compared to glucose: creatinine 11.6 ml/min vs. 10.0, urea 19.0 vs. 16.6, urate 9.5 vs. 8.0; p < or = 0.01 for all. This points to an increased effective peritoneal surface area during amino acids. The clearances of the macromolecules beta 2-microglobulin and alpha 2-macroglobulin were also greater with the amino acid dialysis solution (p < 0.05), but there was only a small increase in the clearances of albumin and IgG. The increase in albumin loss during the 4-hour dwell with amino acids was only marginal. The MTACs of nitrate and cGMP were similar with the 2 solutions, without evidence of local production of these solutes. No difference was found between the 2 solutions in the dialysate concentrations of the prostaglandins PGE2, 6-keto-PGF1 alpha, PGF2 alpha and TxB2. The transcapillary ultrafiltration rate was higher during the amino acid dwell (p < 0.01), but no significant difference in net ultrafiltration was found, because the lymphatic absorption tended to be slightly greater with amino acids. The difference in transcapillary ultrafiltration with the 2 solutions was probably blood flow dependent, as the peritoneal filtration fraction was essentially the same in the 2 experiments. It is concluded that amino acid dialysis solution had a vasoactive effect. It mainly influenced the peritoneal blood flow and the effective peritoneal surface area. These effects could not be attributed to NO, as judged from nitrate or cGMP MTACs.
1.1%氨基酸透析液（Nutrineal）含有L-精氨酸，它是一氧化氮（NO）合成的底物。NO可使许多器官血管舒张。为研究氨基酸透析液对腹膜通透性和灌注的影响，对10例稳定的持续性非卧床腹膜透析（CAPD）患者进行了标准腹膜通透性分析；一组使用Nutrineal，另一组使用葡萄糖透析液（1.36%的Dianeal）。计算硝酸盐和环磷酸鸟苷（cGMP）的传质面积系数（MTAC），以研究NO可能发挥的作用。测量二氧化碳的MTAC以评估腹膜血流量。使用氨基酸溶液进行4小时留腹期间，二氧化碳的MTAC较高：中位数为93毫升/分钟（氨基酸溶液）对60毫升/分钟（葡萄糖溶液）；p<0.01。这表明在输注氨基酸期间腹膜血流量增加。此外，与葡萄糖相比，氨基酸对低分子量溶质的MTAC更大：肌酐为11.6毫升/分钟对10.0，尿素为19.0对16.6，尿酸盐为9.5对8.0；所有比较p均≤0.01。这表明使用氨基酸期间有效腹膜表面积增加。氨基酸透析液对大分子β2-微球蛋白和α2-巨球蛋白的清除率也更高（p<0.05），但白蛋白和免疫球蛋白（IgG）清除率仅略有增加。使用氨基酸进行4小时留腹期间白蛋白丢失的增加仅为微量。两种溶液的硝酸盐和cGMP的MTAC相似，没有证据表明这些溶质在局部产生。两种溶液在前列腺素PGE2、6-酮-PGF1α、PGF2α和血栓素B2（TxB2）的透析液浓度方面没有差异。氨基酸留腹期间毛细血管超滤率较高（p<0.01），但净超滤量没有显著差异，因为氨基酸的淋巴吸收倾向于略高。两种溶液在毛细血管超滤方面的差异可能取决于血流量，因为两个实验中的腹膜滤过分数基本相同。结论是氨基酸透析液具有血管活性作用。它主要影响腹膜血流量和有效腹膜表面积。从硝酸盐或cGMP的MTAC判断，这些作用不能归因于NO。
