重症急性胆管炎患者氨基酸代谢变化及其临床意义

对２０例急性胆管炎患者的氨基酸代谢变化进行了研究。２０例患者中轻症和重症各１０例，以另１０例无感染的良性胆道患者作对照组。研究结果：胆管炎思考多数氨基酸和总氨基酸的动脉血浆浓度降低，诸氨基酸的动脉－股静脉差负值增大；重症者与轻症者相比，血浆部分氨基酸及总氨基酸水平相对增高，而动脉－股静脉氨基酸差和降低。亮氨酸／酪氨酸清除比率显著增大和尿素氮生成量降低。上述结果表明，急性胆道感染时肌蛋白分解加速，周围氨基酸转流至肝脏等内脏器官；轻、重两型胆管炎之间氨基酸代谢反应的病理差异，是重症胆管炎时肝功能损害所致肝脏清除非支链氨基酸速率减低的结果。

Alteration in amino acid metabolisin in patients withacute cholangitis and its climical significance

Arterial plasma amino acids (AAS).femoralarteriovenous differences(AVD).leucine/tyrosineclearance(L/TCLR)and urea nitrogen production(UNP)were measured it 20 patients with acutecholangitis(AC),and compared with those in 10nonseptic patients with similar primary biliary dis-eases.Plasma amino acid patterns exhibited low arte-rial plasma levels of certain kinds of AAs and totalAAS.and elevated.levels of phenylalanine andtaurine in most ACD patients in whom increased totalAVD was found. However,while in patients withacute cholangitis of severe type(ACST),plasma levelof total AAS was higher,total AVD lower the in thepatients with acute cholangitis of mild type (ACMT)L/TCLR,an index of hepatic function,remainedunchanged with elevated UNP in the ACMT group,but it was dramatically increased with reduced UNPin the ACT patients.These data show that ACMT isassociated with muscle protein catabolism andenhancement of uregenesis.But in ACSR with im-paired liver metabolism,a marked inhibition of ureasynthesis .occurs The difference in the metabolicchanges between these two types of AC can be par-tially atributed to a decreased bepatic clearancerate of non-branched-chain AAS.