Timokhov V S, Kazakov I V, Ipat'eva E I, Iakovleva I I, Azizov Iu M, Iarustovskiĭ M B, Grigor'iants R G, Abramian M V
Ter Arkh. 1998;70(6):26-9.
Investigation of postaggressive reaction of metabolism on intermitten hemofiltration (IHF) in patients with acute renal failure (ARF). The speed of generation of urea, creatinine and oligopeptides was estimated in the course of (IHF) and in interval between the procedures. Hormonal stress was evaluated by concentration of hydrocortisone in plasma and and filtrate.
The trial covered 36 patients with oliguric ARF (21 males and 15 females) for whom IHF was the main method of replacement renal therapy. The kinetic modelling accounted for distinctive distribution of markers in body fluids. Statistical processing was made according to Student-Fisher T-criterion.
IHF runs with intensive proteinolysis with acceleration of oligopeptides generation by 810%, degradation of large quantities of creatine triphosphate and 770%-accelerated production of creatinine, with protein catabolism and 440%-accelerated production of urea. Hydrocortisone blood levels rise about two-fold despite intensive elimination of the hormone with filtrate. Between speeds of IHF, generation of creatinine and secretion a direct correlation was found. This indicates the importance of the perfusion rate for induction of the stress and catabolism. Background hydrocortisone Irvrl has significant effects only on urea accumulation rates in IHF-free intervals. However, in the course of IHF, generation of urea and oligopeptides is to a great extent independent of hydrocortisone secretion.
Application of IHF in ARF patients results in rather strong stress with enhanced proteinolysis and protein catabolism. To compensate protein loss associated with only urea generation, additional administration of minimum 60 g of plasma or amino acids is required.
研究急性肾衰竭（ARF）患者在间歇性血液滤过（IHF）过程中攻击后代谢反应。在IHF过程中和各治疗间隙期评估尿素、肌酐和寡肽的生成速度。通过血浆和滤液中氢化可的松的浓度评估激素应激情况。
该试验涵盖36例少尿型ARF患者（21例男性和15例女性），IHF是其主要的肾脏替代治疗方法。动力学模型考虑了标志物在体液中的独特分布。根据Student-Fisher T检验标准进行统计处理。
IHF过程中伴随着强烈的蛋白水解作用，寡肽生成加速810%，大量三磷酸肌酸降解，肌酐生成加速770%，伴有蛋白质分解代谢，尿素生成加速440%。尽管滤液中大量排出激素，但氢化可的松血药浓度仍升高约两倍。发现IHF速度、肌酐生成与分泌之间存在直接相关性。这表明灌注率对诱导应激和分解代谢的重要性。基础氢化可的松Irvrl仅对无IHF间期的尿素积累率有显著影响。然而，在IHF过程中，尿素和寡肽的生成在很大程度上独立于氢化可的松分泌。
ARF患者应用IHF会导致相当强烈的应激反应，蛋白水解和蛋白质分解代谢增强。为补偿仅因尿素生成而导致的蛋白质损失，需要额外补充至少60 g血浆或氨基酸。
