脓毒症患儿氨基酸谱变化及临床意义研究
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摘要
目的观察脓毒症患儿氨基酸水平的变化,为脓毒症患儿合理的全静脉营养(TPN)配比提供理论依据。方法将2014年12月~2015年9月入住成都市妇女儿童中心医院儿童重症监护病房(PICU)的132例脓毒症患儿,在入院24h内行手指采血,用串联质谱仪分析血片中氨基酸谱及其浓度。按患儿白蛋白水平分为血清白蛋白正常组和低白蛋白组,再根据患儿结局分为存活组和死亡组,分别比较两组间氨基酸水平变化情况。结果脓毒症患儿在血清白蛋白正常组和低白蛋白组间,患儿的小儿危重症评分(PCIS)、需要机械通气、死亡率比较,差异均有统计学意义(P<0.05);低蛋白组中患儿血丙氨酸(Ala)、天冬氨酸(ASP)、精氨酸(Arg)、缬氨酸(Val)、酪氨酸(Tyr)、谷氨酸(Glu)、谷氨酰胺(Gln)、组氨酸(His)、甲硫氨酸(Met)、瓜氨酸(Git)、甘氨酸(Glu)、鸟氨酸(Orn)、苏氨酸(Thy)、脯氨酸(Pvo)均存在不同程度的下降,其中丙氨酸、酪氨酸、缬氨酸、组氨酸与白蛋白正常组比较,差异有统计学(P<0.05);脓毒症死亡组中患儿瓜氨酸、精氨酸、谷氨酰胺下降,苯丙氨酸(Phe)升高,与存活组比较,差异统计学意义(P<0.05)。结论脓毒症患儿可出现多种氨基酸含量不同程度降低,死亡组中瓜氨酸、精氨酸、甘氨酸、谷氨酰胺水平低于存活组,苯丙氨酸水平高于存活组,这些氨基酸水平可能与脓毒症患儿预后有关。
Objective To explore the changes of amino acid levels in children with sepsis and provide a theoretical basis for reasonable TPN in sepsis.Methods 132 children with sepsis enrolled in Children′s Intensive Care Unit(PICU)of Chengdu Women and Children′s Central Hospital from December 2014 to September 2015 were included.The concentration of amino acids in blood was determined by tandem mass spectrometry.According to the level of albumin in children divided into serum albumin normal group and low albumin group,according to the outcome of children divided into survival group and death group,the levels of amino acids were compared between the two groups.Results There was a significant difference(P<0.05)in Pediatric Critical Rating,Mechanical ventilation rate and mortality between serum albumin normal group and low albumin group.In addition,the decreased alanine,aspartic acid,Arginine,valine,tyrosine,glutamic acid,glutamine,histidine,methionine,citrulline,ornithine and increased phenylalanine were found in hypoalbuminemia group,meanwhile the changed levels of alanine,tyrosine,valine,histidine were statistically significant(P<0.05)compared with the normal albumin group.The death group with citrulline,arginine,glutamine decreased,phenylalanine increased,compared with the survival group with significant difference(P<0.05).Conclusion Many kinds of amino acid content in children with sepsis can be reduced to varying degrees,the death group,citrulline,arginine,glycine,glutamine level is lower than the survival group,phenylalanine levels higher than the survival group,the level of these amino acids may be related to the prognosis of patients with sepsis.
Objective To explore the changes of amino acid levels in children with sepsis and provide a theoretical basis for reasonable TPN in sepsis.Methods 132 children with sepsis enrolled in Children′s Intensive Care Unit(PICU)of Chengdu Women and Children′s Central Hospital from December 2014 to September 2015 were included.The concentration of amino acids in blood was determined by tandem mass spectrometry.According to the level of albumin in children divided into serum albumin normal group and low albumin group,according to the outcome of children divided into survival group and death group,the levels of amino acids were compared between the two groups.Results There was a significant difference(P<0.05)in Pediatric Critical Rating,Mechanical ventilation rate and mortality between serum albumin normal group and low albumin group.In addition,the decreased alanine,aspartic acid,Arginine,valine,tyrosine,glutamic acid,glutamine,histidine,methionine,citrulline,ornithine and increased phenylalanine were found in hypoalbuminemia group,meanwhile the changed levels of alanine,tyrosine,valine,histidine were statistically significant(P<0.05)compared with the normal albumin group.The death group with citrulline,arginine,glutamine decreased,phenylalanine increased,compared with the survival group with significant difference(P<0.05).Conclusion Many kinds of amino acid content in children with sepsis can be reduced to varying degrees,the death group,citrulline,arginine,glycine,glutamine level is lower than the survival group,phenylalanine levels higher than the survival group,the level of these amino acids may be related to the prognosis of patients with sepsis.
引文
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[7]范江花,祝益民,胥志跃,等.脓毒症患儿血清白蛋白水平变化[J].临床儿科杂志,2013(10):941-945.
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[10]卢阳珍,方强,方雪玲.脓毒症患者氨基酸谱的变化及其临床意义[J].中国急救医学,2006,26(1):58-59.
[11]戚仁斌,陆大祥,王华东,等.甘氨酸拮抗内毒素性离体心脏损伤的作用研究[J].中国药理学通报,2005,21(6):738-741.
[12]Asgeirsson T,Zhang S,Nunoo R,et al.Citrulline:apotential immunomodulator in sepsis.[J].Surgery,2011,150(150):744-751.
[13]Curis E,Crenn P,Cynober L.Citrulline and the gut[J].Curr Opin Clin Nutr Metab Care,2007,10(5):620-626.
[14]Calisto K L.Diacerhein attenuates the inflammatory response and improves survival in a model of severe sepsis[J].Critical Care,2012,16(4):1-13.
[15]Yeh S L,Lai Y N,Shang H F,et al.Effects of glutamine supplementation on innate immune response in rats with gut-derived sepsis[J].British Journal of Nutrition,2004,91(3):423-429.
[16]杨新利,钱素云.脓毒性脑病发病机制研究进展[J].国际儿科学杂志,2005,32(3):168-170.
[17]黄伟,万献尧,孟玉兰,等.2014重症医学回顾与展望[J].中华危重病急救医学,2015,27(1):3-9.
[2]李海玲,任红贤,娄云鹏.肠道循环对早期肠内营养的挑战[J].中国中西医结合急救杂志,2015,22(1):15-17.
[3]Dellinger RP,Carelet JM,Masur H,et al.Surviving sepsis campaign guidelines formanagement of severe sepsis and septic shock[J].CritCareMed,2004,32(3):858-873.
[4]韩连书,高晓岚,叶军,等.串联质谱检测干血滤纸片氨基酸方法的建立[J].检验医学,2005,20(3):220-223.
[5]中华医学会儿科学分会急救学组,中华医学会急诊分会儿科学组,中华儿科杂志.儿科感染性休克(脓毒性休克)诊疗推荐方案[J].中国小儿急救医学,2006,13(4):313-315.
[6]卢阳珍,方强,方雪玲.脓毒症患者氨基酸谱的变化及其临床意义[J].中国急救医学,2006,26(1):58-59.
[7]范江花,祝益民,胥志跃,等.脓毒症患儿血清白蛋白水平变化[J].临床儿科杂志,2013(10):941-945.
[8]Wijnands K A,Brink P R,Weijers P H,et al.Impaired fracture healing associated with amino acid disturbances[J].American Journal of Clinical Nutrition,2012,95(5):1270-1277.
[9]Kung S P,Wu C W,Lui W Y.Arginine modulated cyclosporineinduced immune suppression in rats transplanted with gastric cancer cells[J].Vivo,2001,15(1):39-44.
[10]卢阳珍,方强,方雪玲.脓毒症患者氨基酸谱的变化及其临床意义[J].中国急救医学,2006,26(1):58-59.
[11]戚仁斌,陆大祥,王华东,等.甘氨酸拮抗内毒素性离体心脏损伤的作用研究[J].中国药理学通报,2005,21(6):738-741.
[12]Asgeirsson T,Zhang S,Nunoo R,et al.Citrulline:apotential immunomodulator in sepsis.[J].Surgery,2011,150(150):744-751.
[13]Curis E,Crenn P,Cynober L.Citrulline and the gut[J].Curr Opin Clin Nutr Metab Care,2007,10(5):620-626.
[14]Calisto K L.Diacerhein attenuates the inflammatory response and improves survival in a model of severe sepsis[J].Critical Care,2012,16(4):1-13.
[15]Yeh S L,Lai Y N,Shang H F,et al.Effects of glutamine supplementation on innate immune response in rats with gut-derived sepsis[J].British Journal of Nutrition,2004,91(3):423-429.
[16]杨新利,钱素云.脓毒性脑病发病机制研究进展[J].国际儿科学杂志,2005,32(3):168-170.
[17]黄伟,万献尧,孟玉兰,等.2014重症医学回顾与展望[J].中华危重病急救医学,2015,27(1):3-9.