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脓毒症中的代谢改变

Metabolic Alterations in Sepsis.

作者信息

Wasyluk Weronika, Zwolak Agnieszka

机构信息

Chair of Internal Medicine and Department of Internal Medicine in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland.

Doctoral School, Medical University of Lublin, 20-093 Lublin, Poland.

出版信息

J Clin Med. 2021 May 29;10(11):2412. doi: 10.3390/jcm10112412.

Abstract

Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". Contrary to the older definitions, the current one not only focuses on inflammation, but points to systemic disturbances in homeostasis, including metabolism. Sepsis leads to sepsis-induced dysfunction and mitochondrial damage, which is suggested as a major cause of cell metabolism disorders in these patients. The changes affect the metabolism of all macronutrients. The metabolism of all macronutrients is altered. A characteristic change in carbohydrate metabolism is the intensification of glycolysis, which in combination with the failure of entering pyruvate to the tricarboxylic acid cycle increases the formation of lactate. Sepsis also affects lipid metabolism-lipolysis in adipose tissue is upregulated, which leads to an increase in the level of fatty acids and triglycerides in the blood. At the same time, their use is disturbed, which may result in the accumulation of lipids and their toxic metabolites. Changes in the metabolism of ketone bodies and amino acids have also been described. Metabolic disorders in sepsis are an important area of research, both for their potential role as a target for future therapies (metabolic resuscitation) and for optimizing the current treatment, such as clinical nutrition.

摘要

脓毒症被定义为“由宿主对感染的失调反应引起的危及生命的器官功能障碍”。与过去的定义不同,当前的定义不仅关注炎症,还指出了包括代谢在内的体内稳态的系统性紊乱。脓毒症会导致脓毒症诱导的功能障碍和线粒体损伤,这被认为是这些患者细胞代谢紊乱的主要原因。这些变化会影响所有常量营养素的代谢。所有常量营养素的代谢都会发生改变。碳水化合物代谢的一个特征性变化是糖酵解增强,这与丙酮酸进入三羧酸循环的失败相结合,会增加乳酸的形成。脓毒症还会影响脂质代谢——脂肪组织中的脂解作用上调,这会导致血液中脂肪酸和甘油三酯水平升高。与此同时,它们的利用受到干扰,这可能导致脂质及其有毒代谢产物的积累。酮体和氨基酸代谢的变化也有描述。脓毒症中的代谢紊乱是一个重要的研究领域,这既是因为它们作为未来治疗靶点(代谢复苏)的潜在作用,也是因为优化当前的治疗方法,如临床营养。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b9a2/8197843/c6adb1cf0958/jcm-10-02412-g001.jpg

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