Shaw J H, Wolfe R R
Ann Surg. 1987 Apr;205(4):368-76. doi: 10.1097/00000658-198704000-00005.
The rates of glycerol and free fatty acid (FFA) kinetics in normal volunteers (VOL), non-weight-losing (NWL) gastrointestinal cancer patients, weight-losing (WL) gastrointestinal cancer patients, and in severely septic patients, using constant infusions of d-glycerol and 1-13C palmitic acid; were determined. Rates of FFA oxidation have also been quantitated. Measurements were made in the basal state, during glucose infusion (4 mg/kg/min), and during total parenteral nutrition (TPN). Rates of glycerol and FFA appearance (Ra) in volunteers and NWL cancer patients were similar, and in both groups there was a significant suppression after glucose infusion. The basal Ra values for glycerol and FFA were 2.4 +/- 0.2 and 6.5 +/- 0.8 mumol/kg/min, respectively, in the volunteers, and in the NWL cancer patients the corresponding values were 2.7 +/- 0.4 and 7.1 +/- 1.1 mumol/kg/min (not significantly different). Compared with the volunteers, the rates of glycerol and FFA turnover were significantly elevated in both septic patients and WL cancer patients. The values for glycerol and FFA Ra were 6.3 +/- 1.1 and 13.1 +/- 3.0 mumol/kg/min, respectively, in the septic patients. The corresponding values were 4.1 +/- 0.4 and 11.7 +/- 1.6 mumol/kg/min in the WL cancer patients. In contrast to the response seen in the volunteers and NWL cancer patients, glucose infusion did not suppress lipolysis in either the septic or WL cancer patients. In all groups studied, glucose infusion resulted in an increase in FFA recycling. Despite the fact that the WL cancer patients had an increased FFA availability, they were significantly less able to oxidize either endogenous FFA or infused lipid when compared with NWL cancer patients (the basal % of FFA uptake oxidized in WL cancer patients was 10 +/- 2% vs. 18 +/- 3% in NWL cancer patients). In contrast, the septic patients had an enhanced capacity to oxidize either endogenous FFA or infused lipid (the basal % of FFA uptake oxidized was 40 +/- 8%, and during TPN this increased in 65 +/- 10%). From these studies the following was concluded: in terms of lipid kinetics, NWL cancer patients are not significantly different from volunteers; WL cancer patients and septic patients have elevated rates of lipolysis, and in contrast to what was seen in NWL cancer patients and in volunteers, glucose infusion in WL cancer patients and in septic patients does not result in a significant inhibition of lipolysis; and WL cancer patients have an impaired capacity to oxidize either endogenous FFA or infused lipid.(ABSTRACT TRUNCATED AT 400 WORDS)
通过持续输注d -甘油和1 - 13C棕榈酸，测定了正常志愿者（VOL）、非体重减轻（NWL）的胃肠道癌症患者、体重减轻（WL）的胃肠道癌症患者以及严重脓毒症患者中甘油和游离脂肪酸（FFA）的动力学速率；还对FFA氧化速率进行了定量。在基础状态、葡萄糖输注期间（4mg/kg/min）以及全胃肠外营养（TPN）期间进行了测量。志愿者和NWL癌症患者中甘油和FFA的出现率（Ra）相似，且两组在葡萄糖输注后均有显著抑制。志愿者中甘油和FFA的基础Ra值分别为2.4±0.2和6.5±0.8μmol/kg/min，NWL癌症患者的相应值为2.7±0.4和7.1±1.1μmol/kg/min（无显著差异）。与志愿者相比，脓毒症患者和WL癌症患者中甘油和FFA的周转率均显著升高。脓毒症患者中甘油和FFA的Ra值分别为6.3±1.1和13.1±3.0μmol/kg/min。WL癌症患者的相应值为4.1±0.4和11.7±1.6μmol/kg/min。与志愿者和NWL癌症患者的反应不同，葡萄糖输注在脓毒症患者或WL癌症患者中均未抑制脂肪分解。在所有研究组中，葡萄糖输注导致FFA再循环增加。尽管WL癌症患者的FFA可用性增加，但与NWL癌症患者相比，他们氧化内源性FFA或输注脂质的能力明显较低（WL癌症患者中基础FFA摄取氧化的百分比为10±2%，而NWL癌症患者中为18±3%）。相反，脓毒症患者氧化内源性FFA或输注脂质的能力增强（基础FFA摄取氧化的百分比为40±8%，在TPN期间增加到65±10%）。从这些研究中得出以下结论：就脂质动力学而言，NWL癌症患者与志愿者无显著差异；WL癌症患者和脓毒症患者的脂肪分解率升高，与NWL癌症患者和志愿者不同，WL癌症患者和脓毒症患者的葡萄糖输注不会导致脂肪分解的显著抑制；且WL癌症患者氧化内源性FFA或输注脂质的能力受损。（摘要截断于400字）
