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维持性血液透析患者血浆游离氨基酸检测的临床意义 |
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葛煜强 徐元钊 袁敏 丁小强 廖履坦
【摘 要】目的 对维持血液透析患者的血浆游离氨基酸进行测定和分析。方法 用氨基酸自动分析仪测定15例血透患者在一次透析前后的血浆氨基酸谱。结果 血透患者在透析前的必需氨基酸除苯丙氨酸外均较正常对照组降低，其中以缬氨酸、亮氨酸和组氨酸下降为显著；非必需氨基酸中精氨酸、甘氨酸和鸟氨酸明显升高；酪氨酸/苯丙氨酸和丝氨酸/甘氨酸的比值较对照组明显降低。患者在一次透析后的必需和非必需氨基酸均低于透析前水平。结论 血透患者氨基酸异常的原因可能与蛋白质摄入不足、尿毒症毒性物质和酸中毒等有关。
【关键词】血液透析 游离氨基酸
The clinical significance of determination of plasma concentrations of free amino acids in maintenance hemodialysis patients
Ge Yuqiang,Xu Yuanzhao,Yuan Min,et al.
(Department of Nephrology,Zhong Shan Hospital,Shanghai Medical University,200032)
【Abstract】Objective To determine and analyze the plasma free amino acids in maint hemodialysis patients.Methods The plasma concentrations of amino acids were detected by auto amino acid analyzer in 15 hemodialysis patients before and after one procedure of hemodialysis.Results The levels of some essential amino acids like valine,leucine and histidine were significantly lower than those of normal controls.The levels of some nonessential amino acids,especially arginine,glycine and ornithine were significantly elevated than those of normal controls.The ratios of tyrosine/phenylalanine and serine/glycine were also significantly lower than normal controls.The concentrations of all the amino acids decreased after one dialysis procedure.Conclusion The abnormal amino acids pattern of hemodialysis patients may be related with low protein intake,toxic effects of uremia and metabolic acidosis.
【Key words】Hemodialysis Free amino acids
尿毒症时有多种氨基酸代谢异常［1］。血液透析虽可纠正部分尿毒症症状，但氨基酸代谢紊乱等情况继续存在甚至加重。氨基酸代谢紊乱是引起血透患者蛋白质营养不良的重要因素。本研究对15例维持性血透患者的血浆游离氨基酸进行测定和分析。
1 材料和方法
1.1 临床资料 15例维持性血透患者，男9例，女6例。平均年龄44.6(33～62)岁。基础病均为慢性肾小球肾炎。内生肌酐清除率为0.05～0.13ml*s-1/1.73m2，蛋白质分解代谢率为(1.0±0.2)g/kg；透析机为Baxter550，聚砜膜透析器，重碳酸盐透析液。另选6例健康正常人作对照。
1.2 氨基酸测定 仪器和试剂：日立835-50氨基酸自动分析仪，强阳离子交换树脂，茚三酮及不同pH柠檬酸缓冲液。
样品收集与分析过程：血透患者在透析前和透析后即刻抽取静脉血1ml，置于肝素抗凝管中以4000r/min离心分离出血浆。取0.2ml血浆加0.[1] [2] [3] 下一页
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