Huttunen J K
Postgrad Med J. 1971 Oct;47(552):654-9. doi: 10.1136/pgmj.47.552.654.
A review is given of the metabolism of fructose in the mammalian organism, and its significance in medicine. Emphasis is laid upon the absorption and assimilation of fructose through pathways not identical with those of glucose. The metabolism of fructose is largely insulin-independent, although the ultimate fate of fructose carbons is determined by the presence or the absence of insulin. Clinical and experimental work has suggested that fructose may exert beneficial effects as a component of the diet for patients with mild and well-balanced diabetes. Fructose is absorbed slowly from the gut, and does not induce drastic changes in blood sugar levels. Secondly, fructose is metabolized by insulin-independent pathways in the liver, intestinal wall, kidney and adipose tissue. As a consequence of the rapid and efficient utilization of fructose, it has been used widely for intravenous feeding in medicine and surgery. However, it has been shown that the rapid infusion of large amounts of fruetose may cause accumulation of lactic acid in the extracellular fluid. The possibility of lactate acidosis, with concomitant impairment of the acid-base balance, already disturbed, constitutes a relative contraindication to the use of intravenous fructose in the treatment of diabetic ketoacidosis. Fructose is known to accelerate ethanol metabolism in the liver. No well-documented reports on the use of fructose in the treatment of ethanol intoxication have been published, although it has recently been suggested that fructose might be of value in the treatment of delirium tremens. Fructose may be less cariogenic than sucrose, at least in short-term experiments. Long-term trials are lacking, and thus the potential advantages of fructose in preventive odontology have not been determined. Fructose does not seem to have any side-effects when used in reasonable amounts. However, it has been reported that the administration of fructose in large amounts induces hyperlipidemia both in man and in experimental animals. Earlier suggestions concerned with the atherogenic properties of fructose have recently been challenged. The apparent increase in the incidence of coronary disease among sucrose users seems to be a statistical artefact, caused by the increased ingestion of coffee and soft drinks by cigarette smokers.
本文综述了果糖在哺乳动物机体中的代谢及其在医学上的意义。重点阐述了果糖通过与葡萄糖不同的途径进行吸收和同化。果糖的代谢在很大程度上不依赖胰岛素，尽管果糖碳的最终归宿取决于胰岛素的有无。临床和实验研究表明，对于轻度且血糖平衡良好的糖尿病患者，果糖作为饮食的一部分可能发挥有益作用。果糖从肠道吸收缓慢，不会引起血糖水平的剧烈变化。其次，果糖在肝脏、肠壁、肾脏和脂肪组织中通过不依赖胰岛素的途径进行代谢。由于果糖能快速高效地被利用，它已在医学和外科手术中广泛用于静脉输注。然而，已表明快速输注大量果糖可能导致细胞外液中乳酸积累。乳酸酸中毒的可能性，以及随之而来的酸碱平衡受损（酸碱平衡本已紊乱），构成了在治疗糖尿病酮症酸中毒时静脉使用果糖的相对禁忌证。已知果糖能加速肝脏中的乙醇代谢。尽管最近有人提出果糖可能对治疗震颤谵妄有价值，但尚未发表关于使用果糖治疗乙醇中毒的充分文献报道。至少在短期实验中，果糖的致龋性可能比蔗糖小。缺乏长期试验，因此果糖在预防牙科学中的潜在优势尚未确定。适量使用果糖似乎没有任何副作用。然而，有报道称，大量给予果糖会在人和实验动物中诱发高脂血症。早期关于果糖致动脉粥样硬化特性的观点最近受到了挑战。蔗糖使用者中冠心病发病率明显上升似乎是一种统计假象，是由吸烟者咖啡和软饮料摄入量增加所致。
