目的:比较65-70岁的健康受试者和年龄相匹配的3b-4期慢性肾脏病(CKD3b-4)患者的氨基酸(AA)血浆谱和肠道吸收炎症标志物。
方法:将11名健康志愿者与12名CKD3b-4患者在首次门诊控制(T0)和12个月后(T12)进行比较。坚持低蛋白饮食(LPD,通过尿素氮外观评估0.6±0.1g/kg/天)。评估了以下参数:肾功能,营养参数,生物电阻抗分析,血浆20种总氨基酸(TAAs)水平,包括支链氨基酸(BCAAs)和非必需氨基酸(NEAAs)的必需氨基酸(EAAs)。Zonulin和粪便钙卫蛋白标志物用于评估肠通透性/炎症。
结果:4例患者退出研究;在其余8例残余肾功能(RKF)保持稳定,他们的LPD依从性已经上升到0.89克/千克/天,贫血恶化,细胞外体液增加。与健康受试者相比,组氨酸的TAA水平,精氨酸天冬酰胺,苏氨酸,甘氨酸,谷氨酰胺都增加了。未观察到BCAA的变化。随着疾病的进展,CKD患者的粪便钙卫蛋白和连蛋白水平显着增加。
结论:这项研究证实了老年患者尿毒症继发的几种AAs血浆水平改变的发现。肠标记物提供CKD患者肠功能相关改变的确认。
A comparison of the amino acid (AA) plasma profile and markers of intestinal absorption-inflammation between healthy subjects aged 65-70 years and age-matched patients affected by stage 3b-4 chronic kidney disease (CKD3b-4) was performed.
Eleven healthy volunteers were compared with 12 CKD3b-4 patients at their first outpatient control (T0) and after 12-months (T12). Adherence to a low protein diet (LPD, 0.6 ± 0.1 g/kg/day) was assessed by Urea Nitrogen Appearance. The following parameters were assessed: renal function, nutritional parameters, bioelectrical impedance analysis, plasma levels of 20 total amino acids (TAAs), both essential (EAAs) including branched-chain amino acids (BCAAs) and non-essential (NEAAs). Zonulin and faecal Calprotectin markers were used to evaluate intestinal permeability/inflammation.
Four patients dropped out of the study; in the remaining 8 residual kidney function (RKF) remained stable, their LPD adherence had risen to 0.89 g/kg/day, anaemia had worsened and extracellular body fluid had increased. In comparison to healthy subjects, TAA levels of histidine, arginine, asparagine, threonine, glycine, and glutamine had all increased. No variation in BCAAs was observed. A significant increase was detected in faecal calprotectin and zonulin levels in CKD patients as the disease progressed.
This study confirms the finding in aged patients of an alteration in plasmatic levels of several AAs secondary to uraemia. Intestinal markers provide confirmation of a relevant alteration to the intestinal function in CKD patients.