Effect of major hepatectomy on glucose and lactate metabolism
Effect of major hepatectomy on glucose and lactate metabolism
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DOI：
10.1097/00000658-199904000-00009
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发表时间：
1999-04-01
影响因子：
9
通讯作者：
Leverve, X
中科院分区：
文献类型：
--
作者：
Chioléro, R;Tappy, L;Leverve, X
背景肝脏在葡萄糖和乳酸代谢中起着重要作用。因此，大范围肝切除术可能会引起血糖和乳酸代谢的改变。方法研究对象为13名受试者：6名肝大部切除术后患者和7名健康受试者，他们都曾禁食一夜。用6，6(2)H葡萄糖测定葡萄糖周转率。用两种互补的方法评估乳酸代谢：(13)C-13-葡萄糖合成和(13)外源性C-13标记的乳酸负荷输注15min后产生的二氧化碳，然后用双指数模型拟合乳酸负荷后185分钟的血乳酸浓度，以计算乳酸清除量、内源性产量和半衰期。与健康对照组相比，患者内源性葡萄糖生成正常，C-13-乳酸氧化和转化为葡萄糖，基础血浆乳酸浓度、乳酸清除量和乳酸内源性生成相似，血浆乳酸半衰期1降低，半衰期2延长。结论肝大部切除术后患者血糖和乳酸代谢维持良好，肝功能储备较大。正常肝实质大小缩小不会导致高乳酸血症。然而，使用药代动力学模型可以检测乳酸代谢的细微变化。
Background The liver plays an important role in glucose and lactate metabolism. Major hepatectomy may therefore be suspected to cause alterations of glucose and lactate homeostasis.Methods Thirteen subjects were studied: six patients after major hepatectomy and seven healthy subjects who had fasted overnight. Glucose turnover was measured with 6,6(2)H glucose. Lactate metabolism was assessed using two complementary approaches: C-13-glucose synthesis and (13)CO2 production from an exogenous C-13-labeled lactate load infused over 15 minutes were measured, then the plasma lactate concentrations observed over 185 minutes after lactate load were fitted using a biexponential model to calculate lactate clearance, endogenous production, and half-lives.Results Three to five liver segments were excised. Compared to healthy controls, the following results were observed in the patients: 1) normal endogenous glucose production; 2) unchanged C-13-lactate oxidation and transformation into glucose; 3) similar basal plasma lactate concentration, lactate clearance, and lactate endogenous production; 4) decreased plasma lactate half-life 1 and increased half-life 2.Conclusions Glucose and lactate metabolism are well maintained in patients after major hepatectomy, demonstrating a large liver functional reserve. Reduction in the size of normal liver parenchyma does not lead to hyperlactatemia. The use of a pharmacokinetic model, however, allows the detection of subtle alterations of lactate metabolism.