复杂腹腔感染对白蛋白合成速率的影响

目的探讨复杂腹腔感染对白蛋白合成速率的影响。方法前瞻陆收集2009年12月至2010年10月间南京军区南京总医院普通外科研究所收治的肠瘘合并复杂腹腔感染病例（感染组,8例）;另选取同期8名年龄、性别、BMI相匹配的健康志愿者作为对照组。受试者在空腹状态下经外周静脉给予首剂量无菌L-ring-^2H5]-苯丙氨酸溶液（4μmol／kg）,继之以6μmol·kg^-1·h^-1的速度持续输注6h。输注前和输注后的每小时取3ml动脉血：通过GC-MS测定血浆游离氨基酸和掺入到白蛋白中L-ring^2H5]．苯丙氨酸的同位素丰度。结果感染组患者血清总蛋白和白蛋白浓度分别为（62．2±1．0）g／L和（32．5±4．0）g／L,显著低于对照组（74．2±1．7）g／L和（46．1±2．6）g／L;均P〈0．05]。感染组患者C反应蛋白、白细胞计数和体温3项全身炎性反应指标均高于对照组（均P〈0．05）。感染组患者白蛋白合成速率为（5．3±1．6）％／d,显著低于正常对照组的（7．8±1．2）％／d,差异有统计学意义（P〈0．05）。血浆游离氨基酸谱显示,感染组患者血浆谷氨酸高于对照组．苯丙氨酸和脯氨酸低于对照组（均P〈0．05）。结论复杂腹腔感染可明显抑制白蛋白合成,是腹腔感染患者低白蛋白血症的原因之一。

Impact of complicated intra-abdominal infection on albumin synthesis rate

Objective To study the impact of complicated intra-abdominal infections on albumin synthesis rate. Methods Eight patients with complicated intra-abdominal infections associated with intestinal fistula were admitted to the Research Institute of General Surgery at the Jinling Hospital between December 2009 and October 2010. Eight healthy volunteers matched for age, sex, and amino acid pool and from albumin were determined by gas chromatography/mass spectrometry analysis. Results Both plasma total protein concentration (62.2 ±1.0) g/L and plasma albumin concentration (32.5 ±4.0) g/L in patients with complicated intra-abdominal infection were lower compared with controls(74.2±1.7) g/L and (46.1±2.6) g/L, both P<0.05]. Body temperature, neutrophil count and plasma C-reactive protein concentration in patients with infection were significantly greater than the levels in control subjects(P<0.05). Albumin synthesis rate in patients with intra-abdominal infection was significantly lower than that in the control group(5.3±1.6)%/d and(7.8±1.2)%/d respectively, P<0.05]. The measurement of plasma free amino acid concentration showed that plasma glutamic acid level was greater than that in control subjects, and that plasma phenylalanine and proline levels were lower than those in controls. Conclusion Complicated intra-abdominal infection inhibits albumin synthesis rate in patients with intestinal fistula, which may partially contribute to the decrease of plasma albumin concentration.