在重症患者高剂量蛋白质营养期间的生物反应:随机对照试验
Arnold S Kristof1, Mengyin Hong2, Nadia Boufaied3
1Meakins-Christie Laboratories and Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Faculty of Medicine, Montreal, Quebec, Canada; Division of Respirology, Department of Critical Care and Medicine, McGill University, Montreal, Quebec, Canada.
The American journal of clinical nutrition
|July 5, 2025
概括
在重症患者中,高剂量蛋白质补充剂显著增加了全身蛋白质平衡 (WBPB). 这种反应与中性粒细胞介导的杀菌基因特征有关,这表明更高的蛋白质剂量具有潜在的益处.
科学领域:
- 关键护理医学 关键护理医学
- 营养生物化学 营养生物化学
- 分子生物学分子生物学
背景情况:
- 减少蛋白质摄入量与重症患者的不良结果有关.
- 之前的试验表明,蛋白质补充没有益处,可能是由于未知的最佳剂量和对生物反应的了解不足.
- 个体患者对营养的反应需要进一步调查.
研究的目的:
- 为了确定不同外源蛋白剂量对全身蛋白平衡 (WBPB) 的影响.
- 识别与蛋白质补充剂代谢反应相关的生物标记物.
- 在重症患者中研究蛋白质剂量和WBPB之间的关系.
主要方法:
- 一项随机对照试验比较了高 (2.5 g/kg/d),中等 (1.75 g/kg/d) 和通常 (0.8 g/kg/d) 的亲肠氨基酸剂量,持续48小时.
- 13C-氨酸稳定同位素动力学测量了全身蛋白质的合成和分解.
- 血液转录组分析 (RNA测序) 确定了与WBPB变化相关的分子特征.
主要成果:
- 高剂量的蛋白质补充剂导致WBPB的显著增加,与通常和中等剂量相比.
- 增加的WBPB与较低的基线蛋白质平衡相关.
- 中性粒细胞杀菌基因特征的减少表达与WBPB的增加有关.
结论:
- 接受高剂量蛋白质补充剂的重症患者显示WBPB的增加更大.
- 这些增加与一种生物程序有关,表明中性粒细胞介导的细菌杀死.
- 最佳的蛋白质剂量策略可能会影响严重疾病中的代谢反应和免疫功能.
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