血浆置换联合乳果糖治疗重症肝炎对血浆氨基酸谱变化的影响

Changes of Serum Amino Acids for the Treatment of PE United Lactulose on Severe Hepatitis Patients

目的 明确重症肝炎氨基酸谱变化的特点 ,探讨血浆置换 (PE)及血浆置换联合乳果糖治疗对其的影响。方法 检测血浆置换及其联合乳果糖治疗的重症肝炎患者各 2 0例 ,分析其氨基酸谱变化特点及氨基酸变化与PTA改善的关系。结果 重症肝炎患者血清蛋氨酸、酪氨酸、苯丙氨酸浓度显著增高 ,亮氨酸、异亮氨酸、缬氨酸浓度和BCAA/AAA比值显著下降 (均P <0 .0 1) ;PE及PE联合乳果糖治疗组芳香族氨基酸浓度下降 ,支链氨基酸浓度升高 ,BCAA/AAA比值上升 (P <0 .0 5 ) ,联合组与单纯PE组比较有显著差异 (P <0 .0 5 ) ;治疗组BCAA上升值、AAA下降值与PTA增加值呈正相关。结论 重症肝炎患者存在特征性氨基酸谱改变 ,尤以BCAA/AAA比值的改变与肝功能改善显著相关 ,PE治疗能调整氨基酸代谢 ,改善患者肝脏功能 ,联合应用乳果糖可以提高疗效。

Objective To study the characteristic of serum amino acids for severe hepatitis patients through detecting normal person, to treat the patients with plasma exchange and with PE united lactulose and to explore the influence of PE and PE united lactulose on severe hepatitis patients. Methods Fourty patients were randomly divided into PE group and PE united lactulose group, there were 20 patients in each group. Amino-acid analyzer was used to detect the density of serum amino acids, and their changes correlation with PTA′s improvement was evaluated. Results Density of methionine,tyrosine,phenylalanine increased significantly, and density of leucine, isoleucine, valine and BCAA/AAA decreased significantly (P<0.01). Aromatic amino acid in the patients whom were treated with PE and PE united Lactulose decreased, but Branched-chain amino acid heightened, and BCAA/AAA rose, P<0.05. BCAA evaluation value and AAA decrease value of the therapy group were positive correlated with PTA amelioration value. Conclusion severe hepatitis patients have characteristic changes in amino acids, BCAA/AAA can serve as a criterion to evaluate the patient′s liver function. PE can adjust amino acid′s metabolism, and ameliorate the patients′ liver function, and efficacy can be improved by using lactulose combinedly.