Cardiac cachexia -pathophysiology and its mechanisms-

1)心脏患者胰岛素抵抗对14例心血管患者、7例瓣膜病患者、3例动脉硬化病患者和4例缺血性心脏病患者进行了血糖-高胰岛素-葡萄糖钳夹，并与正常志愿者进行了比较。心脏病患者胰岛素代谢率（MCRi）与对照组比较差异无统计学意义，为464.3 vs. [SY.+- .] 92.8vs. [SY.+- .]419.1(]SY.+- . [)60.7ml。分钟m < @D12@ > D1。心脏病患者的M值或葡萄糖代谢明显低于对照组，分别为5.34(]SY.+- -[)1.80和8.56(]SY.+- - [)0.75 mg/kg/min。这些并不取决于疾病的不同。2)对照组的细胞内葡萄糖代谢ree为1265+127 kcal，与患者的1270+150kcal差异无统计学意义。REE/BMR与M值相关，r=0.63, p<0.05。虽然葡萄糖氧化无显著差异，但患者组葡萄糖储存量明显降低，分别为2.31(]SY.+-[)1.37和4.94(]SY.+- [)0.43 mg/kg/min。葡萄糖氧化与M值呈显著正相关（r=0.88, p<0.001.3）。我们建立了用少量活检标本测定组织糖原含量的方法。在癌症患者中，骨骼肌中糖原含量与钳夹研究得到的M值呈正相关，与葡萄糖储存更强。在心脏病患者中，没有观察到这种强烈的相关性（目前重新检查）。能量底物ATP、ADP和AMP用HPLC测定，目前正在分析中。4) elisa法检测与外周血IL-6IL-6的关系。14例患者中仅有2例IL-6显著升高。这些不是M值降低的患者。5)心肌中的葡萄糖转运蛋白免疫组化葡萄糖转运蛋白4在人心肌中被证实。我们构建了Glut4的引物，并检测了Glut4 mRNA在心肌中的存在。最近，我们清楚地记录了心肌中Glut4 mRNA的存在，现在正在通过竞争性RT-PCR持续研究其数量。少

1) Insulin resistance in cardiac patientsEuglycemic hyperinsulinemic glucose clamp was performed in 14 cardiovascular patients, 7 with valvular disease, 3 with arteriosclerotic disease and 4 with is ischmic heart disease and compared with nomal volunteer. Metabolic rate of insulin (MCRi) in cardiac patients were not significantly different from that of control, 464.3(]SY.+-。[)92.8vs. 419.1(]SY.+-。[)60.7ml. min. m<@D12@>D1. M value or glucose metabolized in cardiac patients was significantley lower than that of control, 5.34(]SY.+-。[)1.80 and 8.56(]SY.+-。[)0.75 mg/kg/min, respectively. Those were not dependent upon the difference in disease.2) Intracellular glucose metabolismREE of the control was 1265+127 kcal was not different from 1270+150kcal of patients. REE/BMR was correlated with M value with r=0.63 and p<0.05. Although glucose oxidation was not different, glucose storage was significant ly decreased in patient group, 2.31(]SY.+-。[)1.37 and 4.94(]SY.+-。[)0.43 mg/kg/min, respectiv … More ely. Glucose oxidation and M value were strongly correalted with r=0.88 and p<0.001.3) Glycogen contents in the myocardiumWe have established the method to measure tissue glycogen contents from a small amount of biopsied samples. In the cancer patients, glycogen contents in the skeletam muscle was positively correlated with M value obtained from clamp study, more strongly with glucose storage. In the cardiac patients, those strong correlation was not observed (currently reexamied). Energy substrates, ATP,ADP and AMP,were measured by HPLC and now under analysis.4) Relation with IL-6IL-6 in the peripheral blood was measured by ELIZA.Significant elevation of IL-6 was observed in only 2 out of 14 patients. Those were not the patients with decreased M values.5) Glucose transporters in the cardiac muscleImmunohistochmically glucose transporter4 was documented in the human cardiac muscle. We constructed primers of Glut4 and examined the presence of mRNA of Glut4 in the cardiac muscle. Recently we clearly documented the presence of Glut4 mRNA in the cardiac muscle and are now continuously investigating the quantity by competitive RT-PCR. Less