Tappy Luc, Chioléro René
Department of Physiology, Lausanne University School of Biology and Medicine, Lausanne, Switzerland.
Crit Care Med. 2007 Sep;35(9 Suppl):S531-4. doi: 10.1097/01.CCM.0000278062.28122.A4.
Sepsis and multiple organ failure are characterized by an excessive release of inflammatory mediators and a marked stimulation of stress hormones. These in turn have profound effects on energy and substrate metabolism: energy expenditure is generally increased, and increased lipolysis and fat oxidation are observed. Net protein breakdown occurs and leads to accelerated wasting. Most of these effects can be produced in healthy humans by administration of bacterial endotoxin or by tumor necrosis factor-alpha. Hyperlactatemia is a hallmark of sepsis and critical illness, and its severity is related to mortality. An increased lactate production, possibly secondary to activation of Na-K adenosine 5'-triphosphatase and to muscle mitochondrial dysfunction, is involved. Lactate production by immune cells and wound tissue may also play a role. Long-chain, n-3 polyunsaturated fatty acids have anti-inflammatory effects that may be beneficial in sepsis. They also decrease the stimulation of stress hormones induced by bacterial endotoxin, possibly through an effect exerted at the level of the central nervous sytem. Their use in patients with sepsis does not lead to adverse metabolic effects.
脓毒症和多器官功能衰竭的特征是炎症介质过度释放以及应激激素显著受刺激。这些进而对能量和底物代谢产生深远影响：能量消耗通常增加，且观察到脂肪分解和脂肪氧化增加。发生净蛋白分解并导致加速消瘦。通过给予细菌内毒素或肿瘤坏死因子-α，在健康人体内可产生这些效应中的大多数。高乳酸血症是脓毒症和危重病的一个标志，其严重程度与死亡率相关。涉及乳酸生成增加，这可能继发于钠钾三磷酸腺苷酶的激活和肌肉线粒体功能障碍。免疫细胞和伤口组织产生乳酸也可能起作用。长链n-3多不饱和脂肪酸具有抗炎作用，可能对脓毒症有益。它们还可能通过在中枢神经系统水平发挥的作用，减少细菌内毒素诱导的应激激素刺激。在脓毒症患者中使用它们不会导致不良代谢效应。
