Morimoto Y, Nishida T, Kamiike W, Mizuno H, Kazuo H, Furuya E, Matsuda H
First Department of Surgery, Osaka University Medical School, Suita, Japan.
Surgery. 1996 Nov;120(5):808-15. doi: 10.1016/s0039-6060(96)80088-2.
Although maintenance of adenosine triphosphate (ATP) levels is important to restore liver functions during anoxia, ATP production by oxidative phosphorylation is inhibited during Pringle's maneuver, and only a little ATP can be supplied by glycolysis. The glycolytic activity of the liver is controlled by the nutritional condition and hormones. Enhancement of glycolytic activity by insulin may increase ATP production and thus may protect the liver from ischemia.
Rats were divided into three groups: fasted group, food was withheld for 24 hours; fed group, food was provided ad libitum; and insulin group, fed rats were administered insulin (12 units/kg during a 30-minute period) before portal triad clamping (PTC) was performed. After laparotomy was performed, PTC was performed for 30 minutes. The fructose 2,6-bisphosphate (F-2,6-BP) level, the hepatic levels of lactate and ATP, the bile flow rate, the plasma levels of aspartate transaminase and lactate dehydrogenase, and the indocyanine green clearance were measured at appropriate times.
The hepatic F-2,6-BP levels before PTC in the fasted, fed, and insulin groups were 6.2 +/- 3.8, 55.6 +/- 10.6, and 122.2 +/- 31.3 nmol/gm dry weight liver, respectively. The glycolytic activity of the insulin group before PTC was significantly enhanced compared with that of the other groups. Lactate was more rapidly accumulated in livers of the insulin group during PTC than in those of the other groups. The ATP level and energy charge during PTC of the insulin group were higher than those of the other groups. The bile flow rate and indocyanine green clearance after PTC were restored in the order of the insulin, fed, and fasted groups.
Insulin administration before PTC increased the hepatic F-2,6-BP content and enhanced glycolytic activity. Insulin pretreatment combined with feeding improved the hepatic energy metabolism during PTC and restored the liver functions after PTC. Insulin has protective effects on the liver during PTC.
尽管维持三磷酸腺苷（ATP）水平对于缺氧期间恢复肝功能很重要，但在普林格尔手法操作期间，氧化磷酸化产生ATP的过程受到抑制，糖酵解只能提供少量ATP。肝脏的糖酵解活性受营养状况和激素控制。胰岛素增强糖酵解活性可能会增加ATP的产生，从而可能保护肝脏免受缺血损伤。
将大鼠分为三组：禁食组，禁食24小时；喂食组，随意进食；胰岛素组，在进行门静脉三联阻断（PTC）前，给喂食的大鼠注射胰岛素（30分钟内12单位/千克）。剖腹术后，进行30分钟的PTC。在适当时间测量果糖2,6-二磷酸（F-2,6-BP）水平、肝脏乳酸和ATP水平、胆汁流速、血浆天冬氨酸转氨酶和乳酸脱氢酶水平以及吲哚菁绿清除率。
禁食组、喂食组和胰岛素组在PTC前肝脏F-2,6-BP水平分别为6.2±3.8、55.6±10.6和122.2±31.3纳摩尔/克干重肝脏。与其他组相比，胰岛素组在PTC前的糖酵解活性显著增强。在PTC期间，胰岛素组肝脏中乳酸的积累比其他组更快。胰岛素组在PTC期间的ATP水平和能荷高于其他组。PTC后胆汁流速和吲哚菁绿清除率按胰岛素组、喂食组和禁食组的顺序恢复。
PTC前注射胰岛素可增加肝脏F-2,6-BP含量并增强糖酵解活性。胰岛素预处理联合喂食可改善PTC期间的肝脏能量代谢，并在PTC后恢复肝功能。胰岛素在PTC期间对肝脏有保护作用。
