Robin A P, Askanazi J, Greenwood M R, Carpentier Y A, Gump F E, Kinney J M
Surgery. 1981 Aug;90(2):401-8.
Hypertriglyceridemia commonly accompanies clinical sepsis and may be caused by increased hepatic production or decreased clearance of triglyceride from the bloodstream. In contrast, enhanced lipid clearing capacity is usually seen after uncomplicated trauma. The purpose of the study was to determine the role of lipoprotein lipase (LPL) in effecting the above changes. Enzyme activity was assayed in skeletal muscle and adipose tissue biopsy samples from 11 normal subjects and from 17 injured and 11 infected surgical patients. Normal subjects after 4 days of 5% dextrose infusion (D5) showed a significant decrease in adipose tissue LPL activity but no change in skeletal muscle activity. Trauma patients after several days of D5 had higher activity in adipose tissue and higher plasma insulin levels than diet-matched control subjects but showed no change in skeletal muscle activity. Infected patients with high plasma triglyceride levels had significantly decreased LPL activity in both tissues. A linear relationship was found between insulin concentration and adipose tissue LPL activity in normal subjects. We conclude that: (1) low tissue LPL activity in sepsis may result in diminished lipid clearance and contribute to hypertriglyceridemia, (2) after trauma, changes in tissue LPL activity as well as other factors such as altered hemodynamics play a role in determining in vivo lipid clearance, and (3) adipose tissue LPL activity is related to the plasma insulin concentration in normal subjects.
高甘油三酯血症常伴随临床脓毒症出现，可能是由于肝脏甘油三酯生成增加或血液中甘油三酯清除减少所致。相比之下，单纯创伤后通常可见脂质清除能力增强。本研究的目的是确定脂蛋白脂肪酶（LPL）在引起上述变化中的作用。对11名正常受试者、17名受伤外科患者和11名感染外科患者的骨骼肌和脂肪组织活检样本进行了酶活性测定。输注5%葡萄糖（D5）4天的正常受试者脂肪组织LPL活性显著降低，但骨骼肌活性无变化。输注D5几天后的创伤患者脂肪组织活性较高，血浆胰岛素水平高于饮食匹配的对照受试者，但骨骼肌活性无变化。血浆甘油三酯水平高的感染患者两种组织中的LPL活性均显著降低。在正常受试者中发现胰岛素浓度与脂肪组织LPL活性之间存在线性关系。我们得出以下结论：（1）脓毒症时组织LPL活性低可能导致脂质清除减少并促成高甘油三酯血症，（2）创伤后，组织LPL活性变化以及其他因素如血流动力学改变在决定体内脂质清除中起作用，（3）在正常受试者中脂肪组织LPL活性与血浆胰岛素浓度相关。
