Bhattacharyya Sudeepa, Ali Mohamed, Smith William H, Minkler Paul E, Stoll Maria S, Hoppel Charles L, Adams Sean H
Arkansas Children's Nutrition Center, Little Rock, Arkansas.
Department of Pediatrics, University of Arkansas for Medical Science, Little Rock, Arkansas.
Am J Physiol Endocrinol Metab. 2017 Dec 1;313(6):E690-E698. doi: 10.1152/ajpendo.00222.2017. Epub 2017 Aug 22.
The period around bariatric surgery offers a unique opportunity to characterize metabolism responses to dynamic shifts in energy, gut function, and anesthesia. We analyzed plasma acylcarnitines in obese women ( = 17) sampled in the overnight fasted/postabsorptive state approximately 1-2 wk before surgery (), the morning of surgery (prior restriction to a 48-h clear liquid diet coupled in some cases a standard polyethylene glycol gut evacuation: ), and following induction of anesthesia (). Comparisons tested if ) plasma acylcarnitine derivatives reflective of fatty acid oxidation (FAO) and xenometabolism would be significantly increased and decreased, respectively, by preoperative gut preparation/negative energy balance ( vs. ), and ) anesthesia would acutely depress markers of FAO. Acylcarnitines associated with fat mobilization and FAO were significantly increased in : long-chain acylcarnitines (i.e., C18:1, ~70%), metabolites from active but incomplete FAO [i.e., C14:1 (161%) and C14:2 (102%)] and medium- to short-chain acylcarnitines [i.e., C2 (91%), -3-hydroxybutyryl-(245%), C6 (45%), and -3,4-methylene-heptanoyl-(17%), etc.]. Branched-chain amino acid markers displayed disparate patterns [i.e., isobutyryl-(40% decreased) vs. isovaleryl carnitine (51% increased)]. Anesthesia reduced virtually every acylcarnitine. These results are consistent with a fasting-type metabolic phenotype coincident with the presurgical "gut preparation" phase of bariatric surgery, and a major and rapid alteration of both fat and amino acid metabolism with onset of anesthesia. Whether presurgical or anesthesia-associated metabolic shifts in carnitine and fuel metabolism impact patient outcomes or surgical risks remains to be evaluated experimentally.
减肥手术前后的这段时间提供了一个独特的机会，来描述机体对能量、肠道功能和麻醉的动态变化所产生的代谢反应。我们分析了17名肥胖女性在术前约1 - 2周过夜禁食/吸收后状态（）、手术当天早晨（术前限制48小时清流食，部分病例联合标准聚乙二醇肠道准备：）以及麻醉诱导后（）采集的血浆酰基肉碱。比较分析了：）反映脂肪酸氧化（FAO）和异源代谢的血浆酰基肉碱衍生物是否会因术前肠道准备/负能量平衡（与相比）而分别显著增加和减少；）麻醉是否会急性抑制FAO标志物。与脂肪动员和FAO相关的酰基肉碱在时显著增加：长链酰基肉碱（即C18:1，约70%）、活跃但不完全FAO的代谢产物[即C14:1（161%）和C14:2（102%）]以及中短链酰基肉碱[即C2（91%）、-3-羟基丁酰-（245%）、C6（45%）和-3,4-亚甲基庚酰-（17%）等]。支链氨基酸标志物呈现不同模式[即异丁酰-（降低40%）与异戊酰肉碱（增加51%）]。麻醉几乎降低了每种酰基肉碱。这些结果与减肥手术术前“肠道准备”阶段出现的禁食型代谢表型一致，并且随着麻醉开始，脂肪和氨基酸代谢发生了重大且迅速的改变。术前或与麻醉相关的肉碱和燃料代谢变化是否会影响患者预后或手术风险仍有待通过实验进行评估。
