Insulin therapy in burn patients does not contribute to hepatic triglyceride production
Insulin therapy in burn patients does not contribute to hepatic triglyceride production
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DOI：
10.1172/jci200
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发表时间：
1998-05-15
影响因子：
15.9
通讯作者：
Wolfe, RR
中科院分区：
文献类型：
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作者：
Aarsland, A;Chinkes, DL;Wolfe, RR
本文研究了6例严重烧伤患者在接受大剂量外源性胰岛素加葡萄糖促进蛋白质代谢治疗后的脂质动力学变化。患者年龄20+/-2岁(SD)，烧伤面积63+/-8%。按随机顺序进行研究(A)在控制期的第7天喂食状态(C)，单独持续高碳水化合物肠内喂养，(B)在肠内喂养的第7天加外源性胰岛素(200pmol/h=28U/h)，并根据需要额外给予葡萄糖以避免低血糖(I+G)。尽管葡萄糖传递率接近100%，超出能量需要量，但下列脂质参数没有变化：(A)肝脏极低密度脂蛋白甘油三酯(TG)总分泌率(0.165+/-0.138[C]vs.0.154+/-0.138 mmo.kg.d(-1)[I+G])，(B)血浆TG浓度(1.58+/-0.66[C]vs.1.36+/-0.41 mmoL/L[i+G])，和(C)血浆VLDLTG浓度(0.68+/-0.79[C]vs.0.67+/-0.63 mmol/L[I+G])，相反，在胰岛素治疗期间，高碳水化合物摄入使VLDLTG前13+/-5%(C)中从头合成的棕榈酸酯的比例增加到34+/-14%(I+G)，同时脂肪分解产生的棕榈酸酯的量相应减少，同时胰岛素治疗期间VLDLTG中从头合成脂肪酸(FA)的分泌率翻了一番(P&gT；0.5)时，硬脂酸和棕榈酸酯的相对含量分别从35+/-5增加到44+/-8%和4+/-1增加到7+/-2%，油酸和亚油酸的相对浓度分别从43+/-5和8+/-4%下降到37+/-6%和8+/-4%到2+/-2%。血浆胰岛素浓度增加15倍并未改变FA在血浆中的释放速率(8.22+/-2.86[C]vs.8.72+/-6.68 mmol/kg.d(-1)[I+G])。在烧伤患者中，外周FA的释放比内源性肝脏脂肪合成更有可能导致肝脏脂肪堆积，即使在过量摄入碳水化合物和胰岛素治疗的情况下也是如此。
Lipid kinetics were studied in six severely burned patients who were treated with a high dose of exogenous insulin plus glucose to promote protein metabolism. The patients were 20+/-2-yr-old (SD) with 63+/-8% total body surface area burned. They were studied in a randomized order (a) in the fed state on the seventh day of a control period (C) of continuous high-carbohydrate enteral feeding alone, and (b) on the seventh day of enteral feeding plus exogenous insulin (200 pmol/h = 28 U/h) with extra glucose given as needed to avoid hypoglycemia (I + G). Despite a glucose delivery rate similar to 100% in excess of energy requirements, the following lipid parameters were unchanged: (a) total hepatic VLDL triglyceride (TG) secretion rate (0.165+/-0.138 [C] vs. 0.154+/- 0.138 mmol/kg.d(-1) [I+G]), (b) plasma TG concentration (1.58+/-0.66 [C] vs. 1.36+/-0.41 mmol/liter [I+G]), and (c) plasma VLDL TG concentration (0.68+/-0.79 [C] vs. 0.67+/- 0.63 mmol/liter [I+G]), Instead, the high-carbohydrate delivery in conjunction with insulin therapy increased the proportion of de novo-synthesized palmitate in VLDL TG front 13+/-5% (C) to 34+/-14% (I+G), with a corresponding decreased amount of palmitate from lipolysis, In association with the doubling of the secretion rate of de novo-synthesized fatty acid (FA) in VLDL TG during insulin therapy (P > 0.5), the relative amount of palmitate and stearate increased from 35+/-5 to 44+/-8% and 4+/-1 to 7+/-2%, respectively, in VLDL TG, while the relative concentration of oleate and linoleate decreased from 43+/-5 to 37+/-6% and 8+/-4% to 2+/-2%, respectively. A 15-fold increase in plasma insulin concentration did not change the rate of release of FA into plasma (8.22+/-2.86 [C] vs. 8.72+/-6.68 mmol/kg.d(-1) [I+G]. The peripheral release of FA represents a far greater potential for hepatic lipid accumulation in burn patients than the endogenous hepatic fat synthesis, even during excessive carbohydrate intake in conjunction with insulin therapy.