Amino acid composition in parenteral nutrition: what is the evidence?
Amino acid composition in parenteral nutrition: what is the evidence?
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DOI：
10.1097/mco.0b013e328341235a
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发表时间：
2011-01-01
影响因子：
3.1
通讯作者：
Ziegler, Thomas R.
中科院分区：
文献类型：
--
作者：
Yarandi, Shadi S.;Zhao, Vivian M.;Ziegler, Thomas R.
完整的肠外营养液含有混合氨基酸产品，提供所有九种必需氨基酸和不同组成的非必需氨基酸。近年来，关于改变肠外营养氨基酸组成的严格的比较疗效研究很少发表。最近的发现来自随机、双盲、充分有力的临床试验的有限数据，以确定肠外营养中总氨基酸或单个氨基酸的最佳剂量。一个例外是越来越多的关于谷氨酰胺补充肠外营养或作为单一肠外药物给予的功效的研究。在选定的患者中，肠外谷氨酰胺似乎可以带来益处；然而，需要更多的数据来确定最佳谷氨酰胺剂量和可能从这种氨基酸中获益最多的患者亚组。虽然已经发表了一些有前景的研究，但在目前的营养支持时代，关于肠外营养补充不同剂量的精氨酸、支链氨基酸、半胱氨酸或牛磺酸的临床疗效的数据很少。尽管常规使用肠外营养，但令人惊讶的是，很少有临床疗效数据可用于指导需要这种治疗的成人和儿童患者的总或特定氨基酸剂量。这需要研究界和资助机构的更多关注，以更好地确定需要肠外营养的患者亚组的最佳氨基酸给药策略。
Purpose of reviewComplete parenteral nutrition solutions contain mixed amino acid products providing all nine essential amino acids and a varying composition of nonessential amino acids. Relatively little rigorous comparative efficacy research on altered parenteral nutrition amino acid composition has been published in recent years.Recent findingsLimited data from randomized, double-blind, adequately powered clinical trials to define optimal doses of total or individual amino acids in parenteral nutrition are available. An exception is the growing number of studies on the efficacy of glutamine supplementation of parenteral nutrition or given as a single parenteral agent. Parenteral glutamine appears to confer benefit in selected patients; however, additional data to define optimal glutamine dosing and the patient subgroups who may most benefit from this amino acid are needed. Although some promising studies have been published, little data are available in the current era of nutrition support on the clinical efficacy of altered doses of arginine, branched chain amino acids, cysteine, or taurine supplementation of parenteral nutrition.SummaryDespite routine use of parenteral nutrition, surprisingly little clinical efficacy data are available to guide total or specific amino acid dosing in adult and pediatric patients requiring this therapy. This warrants increased attention by the research community and funding agencies to better define optimal amino acid administration strategies in patient subgroups requiring parenteral nutrition.