Thorell A, Alston-Smith J, Ljungqvist O
Department of Surgery, Karolinska Hospital & Institute, Stockholm, Sweden.
Nutrition. 1996 Oct;12(10):690-5. doi: 10.1016/s0899-9007(96)00167-0.
The effect of preoperative glucose infusion on preoperative alterations in hepatic glycogen content, the activity of key hepatic glucoregulatory enzymes (fructose 1,6-diphosphatase [FDPase]), pyruvate kinase (PK), hormonal developments, and plasma levels of free fatty acids (FFA) were investigated in 16 patients undergoing open cholecystectomy. Patients were randomized to receive (group G) or not receive (group C) overnight glucose infusion (5 mg.kg-1.d-1) preoperatively. Infusion of glucose overnight resulted in preoperative elevations of insulin and c-peptide (P < 0.05) and lower plasma levels of FFA, while the same glucose levels were found in both groups, 4.6 mmol/L. During and after surgery, only minor changes in the plasma levels of insulin, c-peptide, catecholamines, glucagon, cortisol, growth hormone, and FFA were found, with minimal differences between groups. The hepatic glycogen content was 65% higher in group G and a significant reduction was confirmed only in this group of patients during surgery. The higher glycogen content was associated with a higher FDPase activity ratio (P < 0.05), which remained unchanged during surgery. In contrast, a significant (P < 0.05) increase in the activity of this enzyme was found in group C. The PK activity ratio did not differ between groups and remained unchanged during surgery. The finding of enhanced FDPase activity suggests that the indirect route (via gluconeogenesis) represents an important contributor to the increased glycogen formation during glucose infusion. Additionally, surgery in the overnight fasted patient induces enzymatic changes favoring gluconeogenesis. Lastly, preoperative high-dose glucose infusion has only minor effects on the endocrine response, plasma levels of FFA, and glycogen depletion during elective open cholecystectomy.
在16例接受开腹胆囊切除术的患者中，研究了术前输注葡萄糖对肝糖原含量术前变化、关键肝糖调节酶（果糖1,6 - 二磷酸酶[FDPase]）、丙酮酸激酶（PK）活性、激素变化以及游离脂肪酸（FFA）血浆水平的影响。患者被随机分为术前接受（G组）或不接受（C组）过夜葡萄糖输注（5 mg·kg⁻¹·d⁻¹）。过夜输注葡萄糖导致术前胰岛素和C肽升高（P < 0.05）以及FFA血浆水平降低，而两组的血糖水平相同，均为4.6 mmol/L。在手术期间及术后，仅发现胰岛素、C肽、儿茶酚胺、胰高血糖素、皮质醇、生长激素和FFA的血浆水平有轻微变化，组间差异极小。G组的肝糖原含量高65%，且仅在该组患者手术期间证实有显著降低。较高的糖原含量与较高的FDPase活性比值相关（P < 0.05），该比值在手术期间保持不变。相比之下，C组该酶的活性有显著（P < 0.05）增加。两组间PK活性比值无差异，且在手术期间保持不变。FDPase活性增强的发现表明间接途径（通过糖异生）是葡萄糖输注期间糖原形成增加的重要因素。此外，过夜禁食患者的手术会诱导有利于糖异生的酶变化。最后，术前高剂量葡萄糖输注对择期开腹胆囊切除术期间的内分泌反应、FFA血浆水平和糖原消耗仅有轻微影响。
