Portacaval anastomosis: brain and plasma metabolite abnormalities and the effect of nutritional therapy.
Portacaval anastomosis: brain and plasma metabolite abnormalities and the effect of nutritional therapy.
复制标题
门腔静脉吻合术：脑和血浆代谢异常及营养治疗的效果。
DOI：
10.1111/j.1471-4159.1984.tb12789.x
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发表时间：
1984
影响因子：
4.7
通讯作者：
Hawkins,RA
中科院分区：
文献类型：
--
作者：
Mans,AM;Biebuyck,JF;Davis,DW;Hawkins,RA
使用门静脉分流术的大鼠作为肝性脑病模型，并与假手术对照进行比较。首先，对血液和全脑中中间代谢物和氨基酸的变化进行了表征，发现分流后 4 周和 7 周时的变化相似。其次，在手术后 5 周评估了营养治疗对大鼠选定代谢物和色氨酸转运至大脑的影响。除去普通食物，并用口服或静脉注射葡萄糖或静脉注射葡萄糖加支链氨基酸治疗大鼠。血浆氨基酸浓度的几种异常通过治疗得以逆转。门静脉分流导致的异常高的脑色氨酸摄取指数并未因任何治疗方案而降低；在口服葡萄糖和葡萄糖加氨基酸的组中，该值甚至更高。计算出的色氨酸、苯丙氨酸和酪氨酸进入大脑的竞争没有改变（葡萄糖加氨基酸），或减少（单独的葡萄糖）。所有治疗均使脑内谷氨酰胺含量接近正常。输注葡萄糖加支链氨基酸使脑中色氨酸、苯丙氨酸和酪氨酸含量正常化，尽管该组中色氨酸的脑摄取指数较高。因此，通过去除口服食物和给予葡萄糖，可以部分或完全逆转门腔分流后发现的几种异常情况。在葡萄糖输液中添加支链氨基酸，通过一种似乎与穿过血脑屏障的转运无关的机制，使三种芳香族氨基酸的脑含量恢复到接近正常。
Rats with portacaval shunts were used as a model of hepatic encephalopathy and compared to sham‐operated controls. First, the changes in intermediary metabolites and amino acids in blood and whole brain were characterized and found to be similar at 4 and 7 weeks after shunting. Second, the effects of nutritional therapy on selected metabolites and tryptophan transport into brain were assessed in rats 5 weeks after surgery. Ordinary food was removed and the rats were treated with glucose given either by mouth or intravenously, or intravenous glucose plus branched chain amino acids. Several abnormalities in plasma amino acid concentrations were reversed by treatment. The abnormally high brain uptake index of tryptophan, a consequence of portacaval shunting, was not lowered by any of the treatment regimens; it was even higher in the groups given glucose by mouth and glucose plus amino acids. Calculated competition for entry of tryptophan, phenylalanine, and tyrosine into brain was unchanged (glucose plus amino aicds), or reduced (glucose alone). Brain glutamine content was brought to near normal by all treatments. Infusion of glucose plus branched chain amino acids normalized brain content of tryptophan, phenylalanine, and tyrosine, even though the brain uptake index of tryptophan was higher in this group. Thus, partial or complete reversal of several abnormalities found after portacaval shunting was achieved by removal of oral food and administration of glucose. The addition of branched chain amino acids to the glucose infusion restored brain content of three aromatic amino acids to near normal, by a mechanism which appeared to be unrelated to transport across the blood‐brain barrier.