Metabolic studies in total parenteral nutrition with lipid in man. Comparison with glucose.
Metabolic studies in total parenteral nutrition with lipid in man. Comparison with glucose.
复制标题
人体脂质全肠外营养的代谢研究。
DOI：
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发表时间：
1976
影响因子：
15.9
通讯作者：
E. Marliss
中科院分区：
文献类型：
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作者：
K. N. Jeejee hoy;G. Anderson;A. Nakhooda;G. Greenberg;I. Sanderson;E. Marliss
对接受全肠外营养方案的患者进行了一项研究，比较了顺序输注非蛋白卡路里时的氮平衡、能量底物、血液氨基酸、免疫活性胰岛素和免疫活性胰高血糖素水平，其中非蛋白卡路里是单独的葡萄糖(葡萄糖系统)，还是83%的Intralipid(加拿大蒙特利尔的Pharmacia Fine Chemals)和17%的葡萄糖(脂肪系统)。这些非蛋白质卡路里是在恒定的氨基酸(每天1克/公斤)、维生素和矿物质的背景下摄入的。每个系统一次输注一周，并随机输注顺序。对部分患者的前臂肌肉进行全血动静脉(A-V)氨基酸水平测定。在葡萄糖系统中，丙酮酸、乳酸、丙氨酸和免疫活性胰岛素的水平明显较高，这与葡萄糖是主要能量来源的情况一致。相比之下，在脂质系统中，游离脂肪酸和酮体增加，而胰岛素下降，这表明脂肪现在是主要的能量来源。尽管有这两种非常不同的代谢情况，但在建立平衡后，两个系统的氮平衡都是正的，达到了相当的程度。相应地，两个系统的全血氨基酸氮的A-V差异表明肌肉对氨基酸氮的摄取程度相当。临床研究表明，本文定义的脂质系统可以通过外周静脉输注长达43天，从而导致体重增加、血清蛋白升高和瘘管愈合。我们的研究表明，由于代谢和临床原因，外源性注入的脂肪是非蛋白质卡路里的合适来源。
A study was undertaken of patients on a regimen of total parenteral nutrition comparing the nitrogen balance, energy substrates, blood amino acids, immunoreactive insulin, and immunoreactive glucagon levels during the sequential infusion of nonprotein calories as either glucose alone (glucose system) or 83% as Intralipid (Pharmacia Fine Chemicals, Montreal, Canada) and 17% glucose (lipid system). These nonprotein calories were administered with a constant background of amino acids (1 g/kg per day), vitamins, and minerals. Each system was infused for a week at a time and the order of infusion randomized. In some patients whole blood arteriovenous (A-V) levels of amino acids were measured across forearm muscle. During the glucose system there was a significantly higher level of pyruvate, lactate, alanine, and immunoreactive insulin, consistent with glucose being the principal source of energy. In contrast, during the lipid system there was a rise in free fatty acids and ketone bodies with a fall in insulin, suggesting that lipid was now the principal source of energy. Despite these two very diverse metabolic situations the nitrogen balance with both systems was positive to a comparable degree after the establishment of equilibrium. Correspondingly, A-V differences of whole blood amino acid nitrogen showed uptake by muscle to an equivalent degree with both systems. Clinical studies indicated that the lipid system as defined herein could be infused by peripheral vein for up to 43 days with resultant weight gain, elevation of serum proteins, and healing of fistulae. Our studies suggest that for both metabolic and clinical reasons exogenously infused lipid is a suitable source of nonprotein calories.