Mechanisms Behind Decreased Endogenous Glucose Production in Malnourished Children
Mechanisms Behind Decreased Endogenous Glucose Production in Malnourished Children
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DOI：
10.1203/pdr.0b013e3181f2b959
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发表时间：
2010-11-01
影响因子：
3.6
通讯作者：
Heikens, Geert Tom
中科院分区：
文献类型：
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作者：
Bandsma, Robert H. J.;Mendel, Marijke;Heikens, Geert Tom
严重营养不良是发展中国家的一个主要健康问题，可能会表现为夸希奥克或消瘦。虽然消瘦是以临床消瘦为特征的，但夸希霍尔克病与外周水肿、氧化应激、低蛋白血症和低血糖有关。低血糖的病因还知之甚少。我们测定了严重营养不良儿童的内源性葡萄糖产生(EGP)。患有夸希霍尔科病、消瘦和对照组的儿童接受预先准备的持续静脉滴注[6，6H(2)]葡萄糖2小时。给予C-13-酮基异己酸(KIC)，在2 h内采集呼气样本，用同位素稀释法计算EGP，并测定(CO2)-C-13/(CO2)-C-12的生成量。平均EGP+/-扫描电子显微镜结果：苦瓜组为5.5+/-0.3 mg/kg/min，软骨病组和对照组分别为6.9+/-0.4 mg/kg/min和7.6+/-0.7 mg/kg/min(P<；0.05苦瓜组与对照组相比)。EGP与血清白蛋白浓度(r=0.67；p<；0.001)和作为氧化应激标志物的尿8-羟基脱氧鸟苷(r=-0.62；p<；0.005)相关。作为肝线粒体功能标志的(CO2)-C-13的分泌在软体病变组明显高于夸西奥克病组和对照组。我们的结论是，严重营养不良儿童的EGP降低与低蛋白血症和氧化应激的程度有关，但与肝细胞线粒体功能的明显缺陷无关。(儿科68：423-428,2010)
Severe malnutrition is a major health problem in developing countries and can present itself as kwashiorkor or marasmus. Although marasmus is characterized by clinical wasting, kwashiorkor is associated with peripheral edema, oxidative stress, hypoalbuminemia, and hypoglycemia. The etiology of the hypoglycemia is poorly understood. We determined endogenous glucose production (EGP) in children with severe malnutrition. Children with kwashiorkor, marasmus, and controls received a primed constant infusion of [6,6H(2)]glucose for 2 h. An i.v. bolus of C-13-ketoisocaproic acid (KIC) was given, and breath samples were obtained during 2 h. Isotope dilution was used to calculate EGP, and (CO2)-C-13/(CO2)-C-12 production was determined. Mean EGP +/- SEM was 5.5 +/- 0.3 mg/kg/min in the kwashiorkor group and 6.9 +/- 0.4 mg/kg/min and 7.6 +/- 0.7 mg/kg/min in the marasmic and control group, respectively, (p < 0.05 kwashiorkor versus marasmus and controls). EGP correlated with serum albumin concentration (r = 0.67; p < 0.001) and urinary 8-hydroxydeoxyguanosine as a marker of oxidative stress (r = -0.62; p < 0.005). (CO2)-C-13 secretion as a marker of hepatic mitochondrial function was significantly higher in the marasmic group compared with kwashiorkor and controls. We conclude that decreased EGP in severely malnourished children is related to the degree of hypoalbuminemia and oxidative stress but is not associated with a clear defect in hepatic mitochonclrial function. (Pediatr Res 68: 423-428, 2010)