透析中输注高张葡萄糖液对血液透析患者血清氨基酸谱的影响

The effect of hypertonic glucose infusion during hemodialysis on serum amino acids spectrum in maintenance hemodialysis patients

目的观察高张葡萄糖液或氨基酸液输注对患者营养状况、生化指标及血清氨基酸谱的影响。方法 32例维持性血液透析患者纳入并完成研究。患者随机分为对照组,葡萄糖干预组,氨基酸干预组。干预组在血液透析过程中分别给予50%葡萄糖液250毫升或8.5%氨基酸250毫升静脉滴注。以主观全面评定法(subjective global assessment,SGA)进行营养评定,采集透析前血液标本进行血清生化代谢指标检测和22种氨基酸浓度测定。结果 6个月后,3组患者的SGA评分较基线均无改变。3组患者均未发现血清白蛋白、前白蛋白较基线升高。葡萄糖干预组必需氨基酸较基线升高(697.0vs.590.5nmol/L,P=0.032),而氨基酸干预组的必需氨基酸较基线呈下降趋势。结论透析中高张葡萄糖输注有助于改善血液透析患者的蛋白质代谢,能量摄入对于氮平衡可能更关键。

Objective To investigate the effect of hypertonic glucose or amino acids infusion through the dialysis circuit on nutrition status, biochemical indexes and serum amino acids spectrum in maintenance hemodialysis（MHD） patients with malnutrition. Methods Thirty-two MHD patients consistent with the inclusion criteria and exclusion criteria were enrolled in this study. They were randomly divided into control group, glucose infusion group（50% glucose 250 ml infusion in every dialysis session） and amino acids infusion group（8.5% amino acids 250 ml infusion in every dialysis session）. Nutrition status was estimated by using Subjective Global Assessment（SGA） method. Serum biochemical indexes were determined, and serum concentrations of the 22 amino acids were measured. Results Six months later SGA levels were similar with the baseline. Elevation of serum albumin and prealbumin compared with baseline levels were not found in three groups. The glucose infusion group had significantly increased levels for concentrations of essential amino acids（697.0 vs. 590.5nmol/L,P=0.032） wherease concentrations of essential amino acids in amino acid infusion group showed decreasing trend. Conclusion Hypertonic glucose infusion during dialysis may improve protein metabolism, suggesting that sufficient energy supply may be more important than nitrogen balance in MHD patients.