Jones M, Hagen T, Boyle C A, Vonesh E, Hamburger R, Charytan C, Sandroni S, Bernard D, Piraino B, Schreiber M, Gehr T, Fein P, Friedlander M, Burkart J, Ross D, Zimmerman S, Swartz R, Knight T, Kraus A, McDonald L, Hartnett M, Weaver M, Martis L, Moran J
Baxter Healthcare Renal Division, McGaw Park, IL 60085, USA.
Am J Kidney Dis. 1998 Nov;32(5):761-9. doi: 10.1016/s0272-6386(98)70131-3.
A peritoneal dialysis (PD) solution containing 1.1% amino acids as the osmotic agent was evaluated in a 3-month randomized, prospective, open-label study in malnourished PD patients. Patients in the treatment group (DAA) received one or two exchanges daily with the amino acid solution, depending on tolerance, in place of glucose solutions. Controls (DD) received their usual therapy with glucose dialysate. Fifty-four DAA and 51 DD patients completed the study. In DAA, but not in DD patients, there was a significant increase at month 3 in serum insulin-like growth factor-1 (IGF-1) levels and significant decreases in serum potassium (all 3 months) and inorganic phosphorus levels (months 1 and 3), indicating a general anabolic response. Prealbumin and transferrin levels were significantly increased in DAA but not in DD patients at month 1, but the groups did not differ at months 2 and 3. In patients with baseline albumin levels less than 3.5 g/dL (bromcresol green [BCG] method), DAA patients showed increases in albumin, transferrin (months 1 and 2), and prealbumin levels (all 3 months) relative to baseline values, whereas these serum protein levels were unchanged in DD patients, although the changes from baseline did not differ between groups. In this subgroup, midarm muscle circumference (MAMC) did not change in DD or DAA patients. In patients with baseline albumin levels of 3.5 g/dL or greater, DD patients had decreases in albumin and total protein levels at all 3 months and in prealbumin levels at months 1 and 2, relative to baseline. In DAA patients, there were fewer changes in serum proteins. MAMC increased significantly from baseline in DAA but not in DD patients, although changes from baseline did not differ between DAA and DD groups. DAA patients showed no changes in peritoneal membrane transport characteristics. The results indicate that treatment with one or two exchanges daily of this amino acid-based PD solution is safe and provides nutritional benefit for malnourished PD patients.
在一项针对营养不良的腹膜透析（PD）患者进行的为期3个月的随机、前瞻性、开放标签研究中，对一种含有1.1%氨基酸作为渗透剂的腹膜透析液进行了评估。治疗组（DAA）患者根据耐受性，每天用氨基酸溶液进行一次或两次交换，以替代葡萄糖溶液。对照组（DD）接受常规的葡萄糖透析液治疗。54名DAA患者和51名DD患者完成了研究。在DAA组患者中，而非DD组患者中，第3个月时血清胰岛素样生长因子-1（IGF-1）水平显著升高，血清钾（整个3个月）和无机磷水平（第1个月和第3个月）显著降低，表明出现了总体合成代谢反应。DAA组患者在第1个月时前白蛋白和转铁蛋白水平显著升高，而DD组患者则未升高，但两组在第2个月和第3个月时无差异。在基线白蛋白水平低于3.5 g/dL（溴甲酚绿[BCG]法）的患者中，DAA组患者的白蛋白、转铁蛋白（第1个月和第2个月）和前白蛋白水平（整个3个月）相对于基线值均有所升高，而DD组患者的这些血清蛋白水平未发生变化，尽管两组相对于基线的变化无差异。在该亚组中，DD组和DAA组患者的上臂中部肌肉周长（MAMC）均未改变。在基线白蛋白水平为3.5 g/dL或更高的患者中，DD组患者在所有3个月时白蛋白和总蛋白水平均降低，在第1个月和第2个月时前白蛋白水平降低，相对于基线水平而言。在DAA组患者中，血清蛋白的变化较少。DAA组患者的MAMC相对于基线显著增加，而DD组患者则未增加，尽管DAA组和DD组相对于基线的变化无差异。DAA组患者的腹膜转运特性未发生变化。结果表明，每天用这种基于氨基酸的腹膜透析液进行一次或两次交换治疗是安全的，并且为营养不良的腹膜透析患者提供了营养益处。
