Thomassen A, Nielsen T T, Bagger J P, Thuesen L
Clin Physiol. 1984 Oct;4(5):425-34. doi: 10.1111/j.1475-097x.1984.tb00127.x.
Myocardial exchanges of glutamate, alanine, glucose, lactate, free fatty acids (FFA) and oxygen in resting state were determined in nine subjects (controls) without and in 28 patients with coronary artery disease (CAD). Patients with CAD showed increased myocardial glutamate uptake (2.51 +/- 0.60 mumol/min) and alanine release (1.25 +/- 0.60 mumol/min) compared to controls (glutamate uptake: 1.66 +/- 0.79 mumol/min; alanine release: 0.63 +/- 0.41 mumol/min). Myocardial glucose and lactate uptake was augmented in CAD patients, whereas FFA arteriovenous differences were decreased in patients with three-vessel-disease. The amount of glutamate taken up by the heart correlated positively to lactate uptake in all subjects (r = 0.84) and to external glucose utilization in patients with CAD (r = 0.72). Myocardial alanine release was positively related to glucose and lactate uptake in controls and in patients with only moderate CAD (one-vessel-disease). Glucose and FFA uptake correlated inversely in controls (r = 0.84), but not in CAD patients. A tight relation between exchanges of glutamate/alanine and carbohydrate metabolism in human heart is demonstrated. The data suggest altered myocardial substrate exchange towards augmented carbohydrate utilization in CAD patients in resting state. The results agree with in vitro and animal studies suggesting extraction of glutamate from the circulation to be of importance for maintaining carbohydrate consumption in chronic ischaemic heart disease.
在9名无冠心病的受试者（对照组）和28名冠心病（CAD）患者中，测定了静息状态下心肌对谷氨酸、丙氨酸、葡萄糖、乳酸、游离脂肪酸（FFA）和氧气的交换情况。与对照组相比（谷氨酸摄取：1.66±0.79μmol/min；丙氨酸释放：0.63±0.41μmol/min），CAD患者的心肌谷氨酸摄取增加（2.51±0.60μmol/min），丙氨酸释放增加（1.25±0.60μmol/min）。CAD患者的心肌葡萄糖和乳酸摄取增加，而三支血管病变患者的FFA动静脉差值减小。在所有受试者中，心脏摄取的谷氨酸量与乳酸摄取呈正相关（r = 0.84），在CAD患者中与外部葡萄糖利用呈正相关（r = 0.72）。在对照组和仅患有中度CAD（单支血管病变）的患者中，心肌丙氨酸释放与葡萄糖和乳酸摄取呈正相关。在对照组中，葡萄糖和FFA摄取呈负相关（r = 0.84），但在CAD患者中并非如此。结果表明，人类心脏中谷氨酸/丙氨酸交换与碳水化合物代谢之间存在紧密关系。数据表明，在静息状态下，CAD患者的心肌底物交换发生改变，趋向于增加碳水化合物的利用。这些结果与体外和动物研究一致，提示从循环中提取谷氨酸对于维持慢性缺血性心脏病中的碳水化合物消耗具有重要意义。
