Lung anabolic activity in patients with chronic heart failure: Potential implications for clinical practice
Lung anabolic activity in patients with chronic heart failure: Potential implications for clinical practice
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DOI：
10.1016/j.nut.2012.01.003
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发表时间：
2012-10-01
期刊：
影响因子：
4.4
通讯作者：
Verri, Manuela
中科院分区：
文献类型：
--
作者：
Aquilani, Roberto;La Rovere, Maria Teresa;Verri, Manuela
目的：肺内的蛋白质处于不断的流动中，经历降解和再合成。我们研究了慢性心力衰竭患者接受或未接受β-受体阻滞剂比索洛尔（BIS）治疗时肺蛋白和氨基酸代谢（重塑过程的生化基础）。临床稳定的慢性心力衰竭康复患者，无代谢性疾病或肝/肾衰竭，并且在前3个月内体重稳定，接受右心导管插入术，和桡动脉插管同时抽取混合中心静脉血和动脉血，计算静脉和动脉的氨基酸差异（肺摄取和释放）。结果：22例接受BIS治疗的患者和8例未接受BIS治疗的患者进行了分析。这两组显示出净肺蛋白质合成（即，苯丙氨酸[静脉-动脉差值] x心脏指数乘积）和氨基酸提取的阳性值，BIS治疗患者的阳性率显著降低。两组均存在肺动脉高压（平均肺动脉压>19 mmHg）。未接受BIS治疗的患者的肺血管阻力比接受BIS治疗的患者高57%（6.65 +/- 2.90 vs 4.23 +/- 1.49 mmHg/L）。min（-1）。m（-2），P < 0.05）。肺血管阻力与肺提取的总必需氨基酸呈正相关（r =+0.4576，P = 0.01）和亮氨酸（r =+0.5083，P = 0.004），对蛋白质合成最重要的氨基酸。慢性心力衰竭患者的氨基酸提取率和肺蛋白质合成率增加，这至少部分表明，肺重塑的速度加快BIS治疗可减轻肺代谢异常。(C)2012 Elsevier Inc. All rights reserved.
Objective: The proteins in the lungs are in constant flux, undergoing degradation and resynthesis. We investigated pulmonary protein and amino acid metabolism, the biochemical basis of the remodeling process, in individuals with chronic heart failure receiving or not receiving beta-blocker therapy with bisoprolol (BIS).Methods: Clinically stable rehabilitative patients with chronic heart failure, without metabolic diseases or liver/renal failure, and with a stable weight over the preceding 3 mo underwent right heart catheterization, and radial artery cannulation. Mixed central venous and arterial blood samples were drawn simultaneously to calculate the venous-arterial difference of amino acids (pulmonary uptake and release).Results: Twenty-two patients on BIS therapy and eight not receiving BIS were analyzed. The two groups showed a net pulmonary protein synthesis (i.e., a positive value of phenylalanine [venous-arterial difference] x cardiac index product) and amino acid extraction, the rates of which were significantly lower in patients on BIS therapy. The two groups had pulmonary hypertension (mean pulmonary artery pressure >19 mmHg). Pulmonary vascular resistance was 57% higher in patients not receiving BIS than in those on BIS therapy (6.65 +/- 2.90 versus 4.23 +/- 1.49 mmHg/L . min(-1) . m(-2), P < 0.05). Pulmonary vascular resistance correlated positively with the pulmonary extraction of total essential amino acids (r = +0.4576, P = 0.01) and leucine (r = +0.5083, P = 0.004), the most important amino acid for protein synthesis.Conclusion: Patients with chronic heart failure have increased rates of amino acid extraction and pulmonary protein synthesis, suggesting, at least in part, an increased rate of lung remodeling. Therapy with BIS attenuates lung metabolic abnormalities. (C) 2012 Elsevier Inc. All rights reserved.