Gut and liver coordinated metabolic response following major torso injury.
Gut and liver coordinated metabolic response following major torso injury.
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严重躯干损伤后肠道和肝脏协调代谢反应。
DOI：
10.1016/0022-4804(92)90274-4
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Banerjee,A
中科院分区：
文献类型：
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作者：
Poggetti,RS;Moore,EE;Moore,FA;Bensard,DD;Parsons,P;Anderson,BO;Banerjee,A
严重创伤引起应激反应，部分通过胰高血糖素、儿茶酚胺和皮质醇介导。这些应激激素调节各种组织对能量底物的选择。虽然葡萄糖和脂肪酸被认为是优选的燃料，但酮体（26/ATP/摩尔）可能是可行的替代品。在这项研究中，我们测定了10例严重创伤患者（修订创伤评分= 6.8 ± 0.5，损伤严重程度评分= 27 ± 3）术后前5天门静脉和体循环中乙酰乙酸和β-羟基丁酸（3-OHB）的浓度。在损伤后6小时，3-OHB在门脉系统中升高（0.34 ± 0.01 mM），而全身性降低（0.09 ± 0.02 mM），表明肠道能够生酮。相反，在24小时，3-OHB全身性升高（0.39 ± 0.02 mM），而门静脉血中降低（0.09 ± 0.01 mM），表明肠道酮消耗。此外，全身酮体比在24小时时升高，表明肝脏能量状态增强。总之，我们认为生酮是由重大创伤刺激的。最初，肠道支持体循环中的酮浓度，而到24小时，肠道成为酮消耗者，肝脏维持循环水平。
Major trauma provokes a stress response which is mediated, in part, via glucagon, catecholamines, and cortisol. These stress hormones modulate the choice of energy substrate for various tissues. While glucose and fatty acids are considered the preferred fuels, ketone bodies (26/ATP/mole) may be a viable alternative. In this study, we measured the concentrations of acetoacetate and β-hydroxybutyrate (3-OHB) in the portal as well as systemic circulations of 10 critically injured patients (revised trauma score = 6.8 ± 0.5, injury severity score = 27 ± 3) during the first 5 postoperative days. At 6 hr postinjury, 3-OHB was elevated in the portal system (0.34 ± 0.01 mM) while depressed systemically (0.09 ± 0.02 mM), indicating that the gut was capable of ketogenesis. In contrast, at 24 hr, 3-OHB rose systemically (0.39 ± 0.02 mM) while decreasing in portal blood (0.09 ± 0.01 mM) implying gut ketone consumption. Moreover, the systemic ketone body ratio became elevated at 24 hr, suggesting an enhanced liver energy status. In summary, we believe ketogenesis is stimulated by major trauma. Initially, the gut supports ketone concentration in the systemic circulation, whereas, by 24 hr, the gut becomes a ketone consumer and the liver maintains circulating levels.