Clinical and experimental studies on protein metabolism in acute hepatic failure-with special relation to effects of branched-chain amino acid infusion

1)临床研究对12例重型肝炎(FH)、12例重型肝炎(AHS)和8例健康对照(HC)静息和输注支链氨基酸(BCAA)溶液(总氨基酸83.6g/L，费氏比37.1,500ml，输注2小时后1h)进行间接量热测定。测量能量消耗(千卡/天和估计基础代谢率的标准化比率；EE/BMR)和碳水化合物、脂肪和蛋白质的氧化量(g/天)。BCAA可显著提高中度代谢FH、AHS和HC患者的EE/BMR，但不影响高代谢FH患者的EE/BMR指数。在中度代谢FH患者、AHS患者和HC患者中，应用支链氨基酸可使蛋白质氧化量增加，但对高代谢FH患者则无影响。结论：支链氨基酸可作为能量底物用于AHS患者和中度…的FH患者。更多的新陈代谢状态。在AHF患者中使用支链氨基酸输注，对能量代谢的精确分析是至关重要的。2)实验研究通过静脉注射脂多糖和D-氨基半乳糖盐酸盐诱导雄性Donryu大鼠AHF。从注射后18h开始，大鼠静脉注射生理盐水、10%葡萄糖、10%氨基酸标准配方，总氮12.2g/L，支链氨基酸/芳香族氨基酸摩尔比37.05，支链氨基酸/芳香族氨基酸摩尔比37.05，4)支链氨基酸富集液，含氮量21.9g/L，比例148.2；各组同时连续输注~(14)&GT；C-亮氨酸，根据动力学模型进行蛋白质代谢分析。与对照组相比，AHF中总蛋白周转率(总通量)、氧化速率和崩解率均显著增加。与生理盐水或10%葡萄糖相比，AHF中输入标准的10%氨基酸配方、支链氨基酸富集液或安慰剂显著增加了总通量和氧化速率。虽然生理盐水、10%葡萄糖、标准10%氨基酸配方和安慰剂对合成速度没有影响，但支链氨基酸富集液显著增加了合成速度。任何解决方案都没有抑制故障的发生。这些结果表明，AHF大鼠处于急性期，三种氨基酸溶液中的任何一种都可以被氧化以在AHF中提供能量。此外，输注支链氨基酸富集液可能通过增加蛋白质合成而具有特定的蛋白质节约作用。较少

1) Clinical studyIndirect calorimetry was performed at resting and at 1 hour after infusion of branched-chain amino acid (BCAA) solution (83.6g total amino acids/L,Fischer's ratio 37.1,500ml for 2hr) in 12 patients with fulminant hepatitis (FH), 12 patients with severe type of acute hepatitis (AHS), and 8 healthy controls (HC). Energy expenditure (Kcal/day and a ratio standardized to the estimated basal metabolic rate ; EE/BMR) and oxidation volumes of carbohydrate, fat and protein (g/day) were measured. EE/BMR was significantly higher in patients with FH and in those with AHS than in HC.Infusion of BCAA significantly raised EE/BMR in moderately metabolic FH,in AHS and in HC,although it did not affect the index in hypermetabolic FH.Increases in the protein oxidation volume were brought by BCAA infusion in moderately metabolic FH,in AHS and in HC but not in hypermetabolic FH.In conclusion, BCAA can be utilized as an energy substrate in patients with AHS and in cases of FH with moderatel … More y metabolic state. Precise analysis of energy metabolism is essential in advance, with a use of BCAA infusion in patients with AHF.2) Experimental studyAHF was induced in male Donryu rats by giving lypopolysaccaride intravenously and D-galactosamine hydrochloride intraperitoneally. From 18 hours after injection, AHF and control rats were given one of the following five solutions intravenously for 6 hours : 1) saline, 2) 10% glucose, 3) standard 10% amino acid formula with total nitrogen content of 12.2g/L and BCAA/aromatic amino acid molar ratio of 37.05,4) BCAA-enriched solution with nitrogen content of 21.9g/L and the ratio of 148.2, or 5) an active placebo against BCAA-enriched solution with nitrogen content of 21.9g/L and the ratio of 37.05. In parallel, each group was given a continuous infusion of ^<14>C-leucine, protein turnover was analyzed according to the kinetic model. When compared with the control, rates of total protein turnover (total flux), oxidation and breakdown all increased significantly in AHF.Infusion of standard 10% amino acid formula, BCAA-enriched solution or the placebo in AHF increased total flux and oxidation significantly as compared with the effect of saline or 10% glucose. Although saline, 10% glucose, standard 10% amino acid formula, and the placebo had no effect on synthesis rate, it was increased significantly with BCAA-enriched solution. Breakdown was not suppressed with any solutions. These results suggest that rats with AHF are in a catebolic state and that any of the three amino acid solutions can be oxidized to provide energy in AHF.In addition, infusion of BCAA-enriched solution may have a specific protein-sparing effect by increasing the protein synthesis. Less