脓毒症患儿血清前白蛋白表达 与氨基酸谱的相关性研究

Correlation between serum prealbumin and aminogram in children with sepsis

摘要:

目的 研究脓毒症患儿血清白清蛋白（PA）与氨基酸谱的变化情况及两者相关性，探讨营养支持 期间联用谷氨酰胺（Gln）联合生长激素（GH）的作用。方法 选取2016 年1 月—2016 年12 月四川省成都 市妇女儿童中心医院收治的128 例脓毒症患儿为观察组，并随机均分为观察A 组与观察B 组，每组64 例；同 期募集30 例健康儿童为对照组。观察A 组开展常规营养支持并加用Gln，观察B 组开展常规营养支持并加 用Gln 和GH。分别于观察组开展营养支持前、营养支持第7 天时，对照组纳入研究当日，检测研究对象的氨 基酸谱、PA 水平，分析氨基酸谱与PA 水平的相关性，并依此分析观察组组内、观察组与对照组、观察A 组 与观察B 组间上述指标的差异。结果 观察组在营养支持前PA、丝氨酸、谷氨酸、甘氨酸、丙氨酸、缬氨 酸、异亮氨酸、亮氨酸、赖氨酸、组氨酸、脯氨酸水平均低于对照组，苏氨酸、半胱氨酸、苯丙氨酸水平均 高于对照组，差异有统计学意义（P <0.05）。营养支持第7 天时，观察组PA 及氨基酸谱异常均有一定改善。 PA 水平与缬氨酸、亮氨酸、异亮氨酸呈正相关（r =0.382、0.475 和0.514，均P =0.000）。营养支持第7 天时， 观察A 组PA、缬氨酸、异亮氨酸、亮氨酸水平高于观察B 组，半胱氨酸、蛋氨酸、酪氨酸、苯丙氨酸、精 氨酸水平低于观察B 组，差异有统计学意义（P <0.05）。观察A 组病死率稍低于观察B 组，但差异无统计学 意义（P >0.05）。结论 脓毒症患儿营养支持前PA 水平较低，缬氨酸、亮氨酸、异亮氨酸、丙氨酸、丝氨酸、 谷氨酸水平下降，苯丙氨酸、苏氨酸、半胱氨酸水平上升；PA 水平与缬氨酸、亮氨酸、异亮氨酸呈正相关； PA 水平及氨基酸谱的变化与患者预后有关；营养支持期间应用Gln 及GH 有助于更好地改善氨基酸谱及PA 异常。

Abstract:

Objective To study the changes of serum prealbumin (PA) and aminogram and their correlation in children with sepsis, and to discuss the effect of nutritional support combined with glutamine (Gln) and growth hormone (GH) for the patients. Methods In this study 128 children with sepsis treated in Chengdu Women’s and Children’s Central Hospital from January to December 2016 were enrolled as the observation group, and randomly divided into observation group A and observation group B, with 64 cases in each group. At the same time 30 healthy children were enrolled as the control group. The patients in the observation group A were treated with routine nutritional support combined with Gln, while those in the observation group B were treated with routine nutritional support combined with Gln and GH. Serum PA and aminogram were observed in the observation group before nutritional support and on day 7 during nutritional support, and in the control group on the day when they were involved in this study. The correlation between PA and aminogram was analyzed, the differences in the observation group at different time, between the observation group and the control group, between the observation group A and the observation group B were compared. Results Before nutritional support, PA, serine, glutamate, glycine, alanine, valine, isoleucine, leucine, lysine, histidine and proline levels in the observation group were significantly lower than those in the control group, while threonine, cysteine and phenylalanine were significantly higher than those in the control group (P < 0.05). On day 7 during nutritional support, PA and aminogram in the observation group became better (P < 0.05). PA was positively correlated with valine, leucine and isoleucine (r = 0.382, 0.475 and 0.514, P < 0.05). On day 7 during nutritional support, PA, valine, isoleucine and leucine levels in the observation group A were significantly higher than those in the observation group B, while the levels of cysteine, methionine, tyrosine, phenylalanine and arginine were obviously lower than those in the observation group B (P < 0.05). Conclusions Before nutritional support, the levels of PA, serine, glutamate, alanine, valine, isoleucine and leucine decline; while the levels of threonine, cysteine and phenylalanine increase in children with sepsis. PA level is positively correlated with valine, leucine and isoleucine. Changes of PA and aminogram are associated with the prognosis of the patients. Nutritional support combined with Glu and GH helps to keep PA and aminogram normal.