血浆内脏蛋白在重症患者营养评估中的是与非

Plasma visceral proteins in nutritional assessment of critically ill patients

血浆内脏蛋白主要由肝脏合成,是用于营养状态评估的传统生物学标志物。在感染、炎症、损伤等导致的急性应激反应下,重症患者的血浆内脏蛋白作为负向急性期反应蛋白,合成代谢降低,分解代谢增强,有助于氨基酸在急性期的转化与流动;炎症反应会造成毛细血管通透性增高,大量血浆内脏蛋白外渗到组织间隙;此外,休克时大量液体复苏也会引起血液稀释。因此,重症患者在急性期测得的血浆内脏蛋白水平与营养状态无明显相关性,且无法准确反映营养治疗的效果。当重症患者进入稳定期,或在不存在明显炎症反应的患者中,血浆内脏蛋白的动态评估可用于反映患者营养状态的变化,血浆内脏蛋白水平的降低还与患者的营养风险及不良预后密切相关。本文针对重症患者血浆内脏蛋白的代谢特点及其在重症患者营养评估中的意义和应用局限性进行总结。

Plasma visceral proteins are mostly synthesized by the liver and are traditional biomarkers for nutritional assessment.During stress response and inflammatory states in critically ill patients,as negative acute phase reactive proteins,the anabolic rate of visceral proteins decreases and the catabolic rate increases.An increase in capillary permeability in the inflammatory reaction leads to plasma visceral proteins extravasating into the interstitial space.In addition,hemodilution caused by fluid resuscitation is also the reason for the decrease of plasma visceral proteins level in critical illness.Therefore,an inconsistent relationship was found between visceral protein plasma levels and nutritional status in the acute phase of critically ill patients,and it also can not accurately reflect the effect of nutritional support.However,in stable critical patients without obvious inflammation,the plasma visceral protein levels can be used to dynamically evaluate the changes in the nutritional status.The decrease in plasma protein levels is associated with nutritional risk and poor prognosis in critical patients.This paper reviewes the metabolic characteristics of plasma visceral proteins in critically ill patients and the significance and limitations of plasma visceral proteins in nutritional assessment of critically ill patients.