Green Pnina, Theilla Miriam, Singer Pierre
aFelsenstein Medical Research Center, Metabolic Laboratory bNursing Department, Steyer School of Health Professions cGeneral intensive Care Department, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel.
Curr Opin Clin Nutr Metab Care. 2016 Mar;19(2):111-5. doi: 10.1097/MCO.0000000000000253.
This article describes recent findings regarding lipid metabolism in critical illness as well as in lipid therapy.
In critical illness, in the presence of a decrease in lipid absorption, adipose tissue lipolysis raises triglyceride levels. High-density lipoprotein and low-density lipoprotein are decreased because of impairment of lecithin-cholesterol acyltransferase, mainly in sepsis. In septic patients, lipid profile may be a predictor of survival. Nonsurvivors have lower levels of high-density lipoprotein and low-density lipoprotein. In metabolomic studies, most of the changes from baseline in septic patients were related to lipid metabolism. Lysophosphatidylcholine was also significantly lower in nonsurviving septic patients.
Lipid profile results are too often neglected by the clinician despite increasing knowledge in the modifications related to septic state as well as the importance of these values in the prognosis of the critically ill. Lipid administration (enterally or parenterally) should be guided by better knowledge of the lipid metabolism of the patient.
本文描述了危重病期间脂质代谢以及脂质治疗的最新研究结果。
在危重病期间，由于脂质吸收减少，脂肪组织脂解作用会提高甘油三酯水平。高密度脂蛋白和低密度脂蛋白水平降低，主要是因为卵磷脂胆固醇酰基转移酶受损，这种情况在脓毒症中尤为明显。在脓毒症患者中，血脂情况可能是生存的一个预测指标。未存活者的高密度脂蛋白和低密度脂蛋白水平较低。在代谢组学研究中，脓毒症患者与基线相比的大多数变化都与脂质代谢有关。未存活的脓毒症患者中溶血磷脂酰胆碱水平也显著降低。
尽管临床医生对脓毒症状态相关的变化以及这些数值在危重病预后中的重要性的认识不断增加，但血脂结果常常被忽视。脂质给药（肠内或肠外）应以更深入了解患者的脂质代谢为指导。
