Protein metabolism and liver disease

被引:47
作者
Charlton, MR
机构
[1] Liver Transplant Unit, Mayo Clinic, Rochester, MN 55905
来源
BAILLIERES CLINICAL ENDOCRINOLOGY AND METABOLISM | 1996年 / 10卷 / 04期
关键词
D O I
10.1016/S0950-351X(96)80771-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In health, the liver orchestrates the metabolism of proteins and amino acids. When the liver is diseased, the regulation of protein metabolism is frequently disturbed. The manifestations of disturbed protein metabolism in liver disease are varied and change with disease aetiology and severity. The hallmarks of protein and amino acid metabolism in liver disease are lowered concentrations of circulating branched-chain and increased concentrations of circulating aromatic amino acids with concomitantly altered amino acid kinetics. The changes in amino acid kinetics in liver disease are characterized by increased endogenous leucine flux, an indicator of protein breakdown, and leucine oxidation in the post-absorptive state (when calculated using a reciprocal-pool model and normalized for body cell mass). In addition, the increase in whole-body protein synthesis in response to an amino acid infusion may be attenuated in patients with cirrhosis. These changes are often accompanied by clinically apparent muscle wasting, manifest as protein-calorie malnutrition, and associated low levels of hepatically synthesized plasma proteins. While the pathogenesis of these changes in protein and amino acid metabolism has not been elucidated, altered levels of circulating hormones, known to affect protein metabolism, are probably important. Lowered levels of micronutrients and trace metals and elevated levels of cytokines may also play a role.
引用
收藏
页码:617 / 635
页数:19
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