JCSM:补充甘氨酸和支链氨基酸对慢性血液透析患者肠道屏障和微生物群的影响

2021-09-24 xiaozeng MedSci原创

补充BCAA和甘氨酸对慢性血液透析患者的细胞因子、食欲介质、肠道通透性、内源性大麻素或粪便 IgA 的血清水平均没有影响

30-55%的慢性血液透析 (HD) 患者会出现肌肉萎缩。肌肉萎缩是由于蛋白质降解增加与蛋白质合成和肌生成减少所导致的。血液透析患者的骨骼肌质量减少与身体功能受损、生活质量低下、住院时间延长和死亡率增加有关,强调了保持肌肉质量以改善临床结果的重要性。

既往研究报道,与支链氨基酸 (BCAA) 相比,甘氨酸增加了具有营养不良特征的慢性血液透析患者的非脂肪质量。还有研究发现肌肉质量与肠道微生物相关。

本研究是一项多中心、随机双盲、交叉研究,旨在评估补充氨基酸对慢性血液透析患者的肠道屏障和微生物群的影响

招募血浆蛋白<38 g/L或体重减轻>5%干重,且每日膳食摄入热量<30 kcal/kg 和摄入蛋白质<1 g/kg的血液透析患者。受试患者随机连续补充甘氨酸或支链氨基酸(7 g,2/日)4 个月,并在交叉补充之前经历了1 个月的清除期。在每次开始和结束补充时检测粪便微生物群(16S rRNA 基因测序)和免疫球蛋白 A(IgA)、血清细胞因子水平、肠道通透性替代标志物、食欲介质和内源性大麻素。

共有27位患者接受了研究干预。多元混合线性回归模型显示,两组间的白介素-6(p=0.002)、胰高血糖素样肽1(p=0.028)、胆囊收缩素(p=0.021)和肽YY(p=0.002)具有显著性差异;但其他评估指标均无明显差异。多种分析模型均未发现补充两类氨基酸对患者有任何影响

细菌群落 Bray-Curtis 相似性的主坐标分析

主坐标分析和置换多变量方差分析 (p=0.0001) 显示受试患者具有很明显的微生物群聚类,但不受补充氨基酸的影响。无论补充哪种氨基酸,慢性透析患者的肠道菌群都呈alpha多样性,而且保持稳定。补充BCAA时,受试患者的副干酪乳杆菌和双歧杆菌会明显减少。

综上所述,补充BCAA和甘氨酸对慢性血液透析患者的细胞因子、食欲介质、肠道通透性、内源性大麻素或粪便 IgA 的血清水平均没有影响。粪便微生物群的总体组成和微生物多样性没有随着甘氨酸或支链氨基酸的补充而改变。

原始出处:

Genton Laurence,Pruijm Menno,Teta Daniel et al. Gut barrier and microbiota changes with glycine and branched-chain amino acid supplementation in chronic haemodialysis patients.[J] .J Cachexia Sarcopenia Muscle, 2021, https://doi.org/10.1002/jcsm.12781

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    2022-02-05 徐岩
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    2021-09-26 habb
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