PLASMA AMINO-ACIDS AS PREDICTORS OF THE SEVERITY AND OUTCOME OF SEPSIS
PLASMA AMINO-ACIDS AS PREDICTORS OF THE SEVERITY AND OUTCOME OF SEPSIS
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DOI：
10.1097/00000658-197911000-00003
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发表时间：
1979-01-01
影响因子：
9
通讯作者：
FISCHER, JE
中科院分区：
文献类型：
--
作者：
FREUND, H;ATAMIAN, S;FISCHER, JE
败血症是一种主要的分解代谢损伤，导致外周能量不足，部分由瘦体质量的增加分解和氨基酸(主要是支链氨基酸)的氧化来弥补。任何一例脓毒症的预后都很难预测，但理论上应该与周围能量缺乏的紊乱程度有关，这可能与血浆氨基酸模式有关。本文对25例脓毒症患者血浆氨基酸及其代谢副产物β-羟基苯乙醇胺进行了研究，并将其作为判别变量，用计算机进行了判别分析和多元回归分析。这两项功能是代谢性败血症脑病的程度，作为脓毒症严重程度和败血症患者最终结局的决定因素。血浆氨基酸图谱显示芳香族和含硫氨基酸、苯丙氨酸、酪氨酸、色氨酸、蛋氨酸、半胱氨酸和牛磺酸水平升高，丙氨酸水平正常，支链氨基酸、缬氨酸、亮氨酸和异亮氨酸水平较低。精氨酸水平非常低。未在脓毒症发作中存活的患者显示出更高浓度的芳香族和含硫氨基酸，而在脓毒症中存活的患者显示出更高浓度的支链氨基酸和精氨酸。以脑病程度作为判断脓毒症严重程度的指标，采用多元逐步判别分析，半胱氨酸、蛋氨酸、苯丙氨酸、异亮氨酸、亮氨酸、缬氨酸的交互作用是脑病患者与非脑病患者的最佳判别函数。在82%的非脑病患者和80%的败血症脑病患者中，这些氨基酸给出了正确的分类。用相同的氨基酸对脓毒症死亡患者和存活患者进行判别分析时，以丙氨酸、半胱氨酸、蛋氨酸、异亮氨酸、精氨酸、酪氨酸和苯丙氨酸的血浆浓度为最佳判别函数，91%的死亡者和79%的存活者被正确分类。脓毒症时能量代谢紊乱和肌肉蛋白质降解可能与预后密切相关。某些氨基酸可能在预测脓毒症的严重程度及其结局中发挥核心作用。
Sepsis is a major catabolic insult resulting in a peripheral energy deficit which is made up in part by increased breakdown of lean body mass and oxidation of amino acids, principally the branched chain amino acids. The prognosis in any given case of sepsis is difficult to predict but should theoretically be related to the degree of disturbance in peripheral energy deficit which may be related to plasma amino acid pattern. Plasma amino acids and some of their metabolic byproducts, the .beta.-hydroxyphenylethanolamines, were studied in 25 septic patients and were used as discriminant variables in a series of computer performed discriminant analyses and multiple regressions. The 2 functions were the degree of metabolic septic encephalopathy as a determinant of the severity of sepsis and the final outcome in the septic patient. Plasma amino acid patterns exhibited elevated levels of the aromatic and sulfur containing amino acids, phenylalanine, tryosine, tryptophan, methionine, cysteine and taurine, normal concentrations of alanine and low normal concentrations of the branched chain amino acids, valine, leucine and isoleucine. Arginine levels were very low. Patients not surviving the septic episode exhibited higher concentrations of aromatic and sulfur containing amino acids, while patients surviving sepsis had higher concentrations of the branched chain amino acids and arginine. When the degree of encephalopathy as a determinant of the severity of sepsis and step-wise discriminant analysis with multiple creascent techniques were used, the best discriminant function between patients with and without encephalopathy resulted from the interaction of cysteine, methionine, phenylalanine, isoleucine, leucine and valine. These amino acids gave a correct classification in 82% of patients with no encephalopathy and 80% of patients with septic encephalopathy. When the same amino acids were used for the discriminant analysis for patients dying of sepsis and patients surviving, the best discriminant function was achieved by using plasma concentrations of alanine, cysteine, methionine, isoleucine, arginine, tyrosine and phenylalanine resulting in 91% of the non-survivors and 79% of the survivors correctly classified. The deranged energy metabolism and muscle protein breakdown in sepsis and the outcome may be closely related. Certain amino acids may play a central role in predicting the severity of sepsis and its outcome.