Cerra F B, Caprioli J, Siegel J H, McMenamy R R, Border J R
Ann Surg. 1979 Nov;190(5):577-86. doi: 10.1097/00000658-197911000-00004.
Proline metabolism was prospectively evaluated in patients with surgical sepsis, cirrhosis, and elective surgical procedures. Significant correlations were found in the septic patients. Proline levels were an excellent indicator of mortality and correlated positively with lactate levels. Lactate and proline were inversely related to total peripheral resistance and oxygen consumption. In septic patients who expired: the metabolites involved in the hepatic pathways of proline degradation were elevated in proportion to proline; lactate, glutamate and proline were directly related to pyruvate; lactate/pyruvate ratios were constant; proline, glutamate, ammonia, ornithine, lactate and pyruvate levels were inversely proportional to oxygen consumption and total peripheral resistance. The primary defects in sepsis seem to be metabolic; there are very strong correlations in time between physiology and metabolism; the metabolic abnormality seems to be a progressive energy-fuel deficit, possibly from a progressive inhibition of substrate entry into the Krebs cycle.
对患有外科脓毒症、肝硬化和接受择期手术的患者进行了脯氨酸代谢的前瞻性评估。在脓毒症患者中发现了显著的相关性。脯氨酸水平是死亡率的一个极佳指标，且与乳酸水平呈正相关。乳酸和脯氨酸与总外周阻力和氧耗呈负相关。在死亡的脓毒症患者中：参与脯氨酸降解肝途径的代谢物与脯氨酸成比例升高；乳酸、谷氨酸和脯氨酸与丙酮酸直接相关；乳酸/丙酮酸比值恒定；脯氨酸、谷氨酸、氨、鸟氨酸、乳酸和丙酮酸水平与氧耗和总外周阻力呈反比。脓毒症的主要缺陷似乎是代谢性的；生理与代谢之间在时间上存在非常强的相关性；代谢异常似乎是一种进行性的能量燃料缺乏，可能是由于底物进入三羧酸循环受到逐渐抑制所致。
