The Change Of Amino Acid Spectrum During Sepsis And It's Influence To Immune Function

1. BackgroundSepsis is a heavy burden of the healthy service in the whole world regardless of the standpoint on economic or sociology.For the past few years,the mortality of sepsis patients constantly reach up to 28. 6%, and the mortality of septic shock also reach up to 62-75%. According to the survey of Angus,the cost of hospitalization used at the sepsis patients were highest in the patients of infant ICU and surgery patient of above one organ exhaustion. Now the data of detailed clinical epidemiology were scanty in our country,but according to calculate,there were three million sepsis patients every year in our county.The metabolic response to sepsis is characterized by hypermetabolism,there exist the phenomenon of autocannibalism.nutritional therapy is the diplo-blade sword to the sepsis patients.If the nutrition substrate is not enough,the metabolism would to be restrict, The ATP generated by cell would decrease,apoptosis accelerate and increase,this is a factor that result organ nonfuntion.Earlier Sepsis,the aim of nutritional support is to mitigate the insufficient nutrition substrate,to prevent cell metabolic disorder,to support the structure and function of and tissular, to participate organism regulation immune and physiologic function, to decrease the generate rate of organ nonfunction.However,overmutrition would make metabolic disorder and organ functional lesion aggravate, increase the energy consumption.Therefore, theproper nutritional support is important to the treatment of sepsis patients. 2 ObjectiveTo explore the change of plasma free amino acid concentrations during sepsis in the intensive care unit of The First Affiliated Hospitol Of Medical College Of Zhe Jiang University,And to analysis the relationship between amino acid and immune function , nitrogen balance , mortality rate.3, material and methods(1), Investigate object:A, internalize standard:the APACHEII score of sepsis patients should be above fifteen, standard of sepsis should according to the standard that established by "International Sepsis Definition Conference in 2001 ",B , elimanation standard:at the recent three day , the sepsis patient has inputed by amino acids or enteral nutrition, renal failure patient, tumor patient.(2) Design of experiments establish experiment group and healthy control group:to observe the change of plasma free amino acid concentrations , 24 urea nitrogen , nitrogen balance , prealbumin , T - lymphocyte , Nk cell HLA-DR CD14. immune globulin and the prognosis at apartly before total parenteral nutrition and after total parenteral nutrition;The end ,To analysis this data. The control group is health majority who were the Blood Donation without Repayment at the area of hangzhou Zhejiang province.(3), Empirical procedure:A, blood plasma aminogram: the pre-processing of blood serum sample:a, accur recipe the blood serum lml,then place it to 10ml plastic centrifuge tube,b, add 4% flave-yl oxybenzoic acid according to 1:3 proportion,then agitate joggle even,c, placethe plastic centrifuge tube to super centrifuge,then let it to centrifugate ten minute by 22000 turn/minute^ take the clear supernatant liquid lml and place it in amino acid analysis analytic sample bottle,in the end analysis by L-8800 aminogram automatic detection meter.1^ the determin of nitrogen balance:first,to survey intake nitrogen and urinary urea nitrogen for 24 hours,then,to work out the nitrogen balance by formula (nitrogen balance= intake nitrogen—24hBUN—4)CU prealbumin:utilize the BeckmaA Coulter Immage machine,agent is the origin reagent,detect approach apply the scattering immunoturbidimetry.D, immune functional parameteninclude T lymphocyte ^ natural killer celK HLA-DR> CD14> immune globulose:utilize the flow cytometry4, Results?^ All the 20 patients of sepsis negative nitrogen balance and prealbumin decreased. Through the total parenteral nutrition ,the propotional index were improved,but the index were also lower compared with that of the normal control.(IX A marked decrease inVah Ile> Le^ A^ Ser and Glu was observed at Sepsis, Thr >Met and Cys increased during sepsis . BCAA/AAA was lower compared with that of the normal control . while Phe/ Tyr increased obviously at every time point. Most.(3).. Immune function index fluctuated within normal range., but complement C3 -, C4 which were decreased.And through the total parenteral nutrition , A marked increase in prealbumin and BCAA was observed, but the Immune function index didn't change markly.5-. Conclusion(J)> The results suggested that the metabolic response to sepsis is characterized by hypermetabolism, increased resting energy expenditure, extensive protein and fat catabolism, negative nitrogen balance.(2k A marked decrease in branch chain amino acid (BCAA)was observed at sepsis patients,but aromatic amino acids(AAA) increased in varying degrees. Through the total parenteral nutrition, all the index of amino acids were increased ,but this kind of nutrition can't contended the demand of the metabolism during sepsis.Therefore ,according to the outcome of this experiment to supply the correct total parenteral nutrition were benefit to the therapy of sepsis.(§k The change of prealbumin possibly influence the prognosis of sepsis patients.dX the metabolic response to sepsis is characterized by hypermetabolisnu Most of the immune function index fluctuated within normal range during sepsis.