实验性单创伤和多发伤后的心脏葡萄糖与脂肪酸转运
Cardiac Glucose and Fatty Acid Transport After Experimental Mono- and Polytrauma.
作者信息
Lackner Ina, Weber Birte, Knecht Deborah, Horst Klemens, Relja Borna, Gebhard Florian, Pape Hans-Christoph, Huber-Lang Markus, Hildebrand Frank, Kalbitz Miriam
机构信息
Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany.
Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany.
出版信息
Shock. 2020 May;53(5):620-629. doi: 10.1097/SHK.0000000000001400.
OBJECTIVE
The aim of this study was to define the influence of trauma on cardiac glucose and fatty acid transport. The effects were investigated in vivo in a porcine mono- and polytrauma model and in vitro in human cardiomyocytes, which were treated simultaneously with different inflammatory substances, mimicking posttraumatic inflammatory conditions.
METHODS AND RESULTS
In the porcine fracture- and polytrauma model, blood glucose concentrations were measured by blood gas analysis during an observation period of 72 h. The expression of cardiac glucose and fatty acid transporters in the left ventricle was determined by RT-qPCR and immunofluorescence. Cardiac and hepatic glycogen storage was examined. Furthermore, human cardiomyocytes were exposed to a defined trauma-cocktail and the expression levels of glucose- and fatty acid transporters were determined. Early after polytrauma, hyperglycemia was observed. After 48 and 72 h, pigs with fracture- and polytrauma developed hypoglycemia. The propofol demand significantly increased posttrauma. The hepatic glycogen concentration was reduced 72 h after trauma. Cardiac glucose and fatty acid transporters changed in both trauma models in vivo as well as in vitro in human cardiomyocytes in presence of proinflammatory mediators.
CONCLUSIONS
Monotrauma as well as polytrauma changed the cardiac energy transport by altering the expression of glucose and fatty acid transporters. In vitro data suggest that human cardiomyocytes shift to a state alike myocardial hibernation preferring glucose as primary energy source to maintain cardiac function.
目的
本研究旨在确定创伤对心脏葡萄糖和脂肪酸转运的影响。在猪的单创伤和多创伤模型中进行体内研究，并在体外用人心肌细胞进行研究，这些心肌细胞同时用不同的炎症物质处理，模拟创伤后炎症状态。
方法与结果
在猪骨折和多创伤模型中，在72小时的观察期内通过血气分析测量血糖浓度。通过RT-qPCR和免疫荧光法测定左心室心脏葡萄糖和脂肪酸转运蛋白的表达。检查心脏和肝脏的糖原储存情况。此外，将人心肌细胞暴露于特定的创伤混合液中，测定葡萄糖和脂肪酸转运蛋白的表达水平。多创伤后早期观察到高血糖。48小时和72小时后，骨折和多创伤的猪出现低血糖。创伤后丙泊酚需求量显著增加。创伤72小时后肝糖原浓度降低。在体内的两种创伤模型以及体外存在促炎介质的人心肌细胞中，心脏葡萄糖和脂肪酸转运蛋白均发生了变化。
结论
单创伤和多创伤均通过改变葡萄糖和脂肪酸转运蛋白的表达来改变心脏能量转运。体外数据表明，人心肌细胞转变为类似心肌冬眠的状态， preferring glucose as primary energy source to maintain cardiac function.（此处英文原文有误，根据前文推测可能是“preferring glucose as the primary energy source to maintain cardiac function”，意为“ preferring glucose as the primary energy source to maintain cardiac function”，意为“以葡萄糖作为主要能量来源以维持心脏功能”） 倾向于以葡萄糖作为主要能量来源以维持心脏功能。
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