Evidence for impaired assimilation of protein in chronic renal failure
Evidence for impaired assimilation of protein in chronic renal failure
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DOI：
10.1046/j.1523-1755.2003.00314.x
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发表时间：
2003-12-01
影响因子：
19.6
通讯作者：
Evenepoel, P
中科院分区：
文献类型：
--
作者：
Bammens, B;Verbeke, K;Evenepoel, P
背景蛋白质营养不良是慢性肾功能衰竭（CRF）的常见发现，并与不良结局相关。我们推测，除了膳食蛋白质摄入不足和代谢改变外，蛋白质同化（消化和吸收）不足可能导致尿毒症蛋白质营养不良的发病机制。在64名健康志愿者和119名CRF患者中通过13 C蛋白呼气试验和/或24小时尿液收集中对甲酚的定量来评估蛋白同化。这两种方法都提供了关于蛋白质同化效率的可靠信息。呼吸试验结果表示为C-13给药剂量的最大百分比（%（max））和试验结束时的累积百分比（%cum（end））。根据肾功能对数据进行分层。与肾小球滤过率（GFR）大于或等于60 mL/min/1.73 m2的受试者相比，GFR < 30 mL/min/1.73 m2的受试者表现出显著较低的呼吸试验蛋白同化参数（%（max）3.97 +/- 0.23 vs. 5.20 +/- 0.23，P = 0.0017; %cum（结束）13.91 +/- 0.86 vs. 17.40 +/- 0.80，P = 0.013）和对甲酚的尿量显著更高（54.88 mg/24小时vs. 28.65 mg/24小时，P = 0.0005）。%（max）（r = 0.399，P < 0.0001）、%cum（end）（r = 0.347，P = 0.0007）和尿对甲酚（r =-0.229，P = 0.007）与GFR显著相关。血清白蛋白与最大尿量%（r = 0.399，P = 0.0002）、最终尿量%（r = 0.408，P = 0.0001）和尿对甲酚排出量（r = 0.186，P = 0.035）显著相关。我们的数据提供了证据表明，蛋白质同化功能受损CRF。这种损伤可能导致CRF患者蛋白质营养不良。
Background. Protein malnutrition is a common finding in chronic renal failure (CRF) and is associated with poor outcome. We hypothesized that besides inadequate dietary protein intake and alterations in metabolism, deficient protein assimilation (digestion and absorption) might contribute to the pathogenesis of protein malnutrition in uremia.Methods. Protein assimilation was evaluated in 64 healthy volunteers and 119 CRF patients by means of a 13 C protein breath test and/or quantification of p-cresol in a 24-hour urine collection. Both approaches provide reliable information on the efficiency of protein assimilation. Breath test results were expressed as maximum percentage of administered dose of C-13 (%(max)) and cumulative percentage at the end of the test (%cum(end)). Data were stratified according to renal function.Results. As compared to subjects with glomerular filtration rate (GFR) greater than or equal to60 mL/min/1.73 m(2), subjects with GFR < 30 mL/min/1.73 m 2 demonstrated significantly lower breath test-derived parameters of protein assimilation (%(max) 3.97 +/- 0.23 vs. 5.20 +/- 0.23, P = 0.0017; %cum(end) 13.91 +/- 0.86 vs. 17.40 +/- 0.80, P = 0.013) and significantly higher urinary output of p-cresol (54.88 mg/24 hours vs. 28.65 mg/24 hours, P = 0.0005). %(max) (r = 0.399, P < 0.0001), %cum(end) (r = 0.347, P = 0.0007), and urinary p-cresol (r = -0.229, P = 0.007) correlated significantly with GFR. Serum albumin correlated significantly with %(max) (r = 0.399, P = 0.0002), %cum(end) (r = 0.408, P = 0.0001), and urinary p-cresol output (r = 0.186, P = 0.035).Conclusion. Our data provide evidence that protein assimilation is impaired in CRF. This impairment might contribute to protein malnutrition in CRF.