Opatrná S, Liska J, Vít L, Hostasová A, Opatrný K
I. interní klinika LF UK a FN, Plzen, Bioanalytická laborator Cepha, Plzeń.
Cas Lek Cesk. 1997 Jun 26;136(13):409-12.
In the patient population which is subjected to haemodialysis or peritoneal dialysis is a high prevalence of protein-energy malnutrition which independently on the causal factor causes a deterioration of their prognosis. To influence protein nutrition in patients on peritoneal dialysis Nutrineal was developed, i.e., a dialysis solution using as an osmotic agent a 1.1% amino acid mixture instead of glucose used as a rule. The objective of the present study was to evaluate the effect of its administration on some nutritional indicators in patients treated by continuous ambulatory peritoneal dialysis (CAPD) and to assess its tolerance.
The authors investigated eight patients aged 45.5 years (29-78 years, median, minimal and maximal value), treated for 19.9 (5-42) months by CAPD. For a period of four weeks Nutrineal was administered once a day instead of glucose based solution to patients without diseases complicating nutrition, with a serum albumin concentration (ALB) below 35 (20-34) g/l. Before treatment and after its termination an anthropometric examination was made, the rate of protein catabolism was examined (PCR), plasma concentrations of total proteins were assessed, as well as ALB, transferrin (TRF) and 14 free amino acids substituted by the dialysis solution. For statistical comparison the paired Wilcoxon test was used. As compared with the baseline value of 0.83 g/kg/24 h after treatment a significant increase of PCR was recorded--to 0.96 g/kg/24 h (p < 0.05) as well as a significant increase of the urea concentration from 18.4 (10.9-34.8) mmol/l to 26.7 (19.6-33) mmol/l (p < 0.05). The value of phosphorus declined significantly from 2.25 (1.6-2.6) to 1.9 (0.9-2.5) mmol/l (p < 0.05). No significant difference was recorded in the anthropometric findings and in concentrations of total proteins, ALB, TRF and amino acids.
Four weeks administration of a solution with amino acids raised significantly the PCR which may be indirect evidence of an anabolic effect and it reduced plasma phosphates which participate in uraemic toxicity. The solution was well tolerated by the patients. Final evaluation of the values of the solution containing amino acids calls for long-term and controlled studies.
在接受血液透析或腹膜透析的患者群体中，蛋白质 - 能量营养不良的患病率很高，无论其病因如何，都会导致预后恶化。为了影响腹膜透析患者的蛋白质营养状况，研发了Nutrineal，即一种透析液，它使用1.1%的氨基酸混合物作为渗透剂，而非通常使用的葡萄糖。本研究的目的是评估其给药对持续非卧床腹膜透析（CAPD）患者某些营养指标的影响，并评估其耐受性。
作者调查了8例年龄为45.5岁（29 - 78岁，中位数、最小值和最大值）的患者，他们接受CAPD治疗19.9（5 - 42）个月。对于营养无并发症且血清白蛋白浓度（ALB）低于35（20 - 34）g/l的患者，连续四周每天给予一次Nutrineal而非葡萄糖基溶液。在治疗前和治疗结束后进行人体测量检查，检测蛋白质分解代谢率（PCR），评估总蛋白、ALB、转铁蛋白（TRF）的血浆浓度以及透析液替代的14种游离氨基酸。采用配对Wilcoxon检验进行统计学比较。与治疗后0.83 g/kg/24 h的基线值相比，PCR显著升高至0.96 g/kg/24 h（p < 0.05），尿素浓度也从18.4（10.9 - 34.8）mmol/l显著升高至26.7（19.6 - 33）mmol/l（p < 0.05）。磷的值从2.25（1.6 - 2.6）mmol/l显著降至1.9（0.9 - 2.5）mmol/l（p < 0.05）。人体测量结果以及总蛋白、ALB、TRF和氨基酸浓度方面未记录到显著差异。
四周给予含氨基酸溶液显著提高了PCR，这可能是合成代谢作用的间接证据，并且降低了参与尿毒症毒性的血浆磷酸盐。该溶液患者耐受性良好。对含氨基酸溶液价值的最终评估需要长期对照研究。
