Petrides A S, Matthews D E, Esser U
Department of Medicine, University of Tennessee Health Science Center, Memphis, USA.
Hepatology. 1997 Oct;26(4):972-9. doi: 10.1002/hep.510260426.
We examined whether a single bout of moderate exercise has a beneficial effect on insulin sensitivity and fuel homeostasis in cirrhosis. Clinically stable cirrhotic patients and age-, sex-, and weight-matched controls participated in insulin clamp studies (either euglycemic hyperinsulinemic or hyperglycemic hyperinsulinemic) in combination with indirect calorimetry and [6,6-2H2]glucose. Three to seven days later, studies were repeated following a single bout of exercise (30 minutes of treadmill exercise at 60% of maximal aerobic capacity). After an overnight fast, following exercise, both cirrhotic and control individuals showed a shift in fuel utilization to enhanced lipid oxidation, decreased glucose oxidation, and increased nonoxidative glucose disposal rates (i.e., glycogen synthesis in muscle) when compared with pre-exercise rates but differences were statistically significant only in the patient group. During euglycemic hyperinsulinemia, insulin-mediated glucose disposal was significantly reduced in cirrhotic patients (3.43 +/- 0.26 vs. 7.36 +/- 0.48 mg/kg/min, P < .01). Following exercise, glucose uptake increased significantly in cirrhotic patients when compared with pre-exercise levels (P < .05) but remained unchanged in the control group. The increase in total body glucose disposal in cirrhotic patients was entirely accounted for by an increase in nonoxidative glucose disposal (0.81 +/- 0.20 vs. 0.51 +/- 0.15 mg/kg/min, P < .05). During combined hyperglycemia/hyperinsulinemia, however, insulin sensitivity was unaffected by exercise in both patients and control individuals. In summary, in cirrhotic patients, a single bout of moderate exercise 1) causes a shift in substrate utilization with an increase in lipid oxidation in the postexercise period that is significantly more pronounced than in controls, and 2) increases insulin sensitivity only during euglycemia but not during the more physiological condition of hyperglycemia. Single bouts of moderate exercise therefore may not have a beneficial effect on the metabolic status of patients with chronic liver disease.
我们研究了单次适度运动是否对肝硬化患者的胰岛素敏感性和能量稳态有有益影响。临床稳定的肝硬化患者以及年龄、性别和体重匹配的对照组参与了胰岛素钳夹研究（正常血糖高胰岛素血症或高血糖高胰岛素血症），并结合间接测热法和[6,6-2H2]葡萄糖。三至七天后，在单次运动（以最大有氧能力的60%在跑步机上运动30分钟）后重复进行研究。经过一夜禁食，运动后，与运动前相比，肝硬化患者和对照组个体的能量利用均发生转变，表现为脂质氧化增强、葡萄糖氧化减少以及非氧化葡萄糖处置率增加（即肌肉中的糖原合成），但差异仅在患者组具有统计学意义。在正常血糖高胰岛素血症期间，肝硬化患者胰岛素介导的葡萄糖处置显著降低（3.43±0.26对7.36±0.48毫克/千克/分钟，P<.01）。运动后，与运动前水平相比，肝硬化患者的葡萄糖摄取显著增加（P<.05），而对照组则保持不变。肝硬化患者全身葡萄糖处置的增加完全由非氧化葡萄糖处置的增加所致（0.81±0.20对0.51±0.15毫克/千克/分钟，P<.05）。然而，在高血糖/高胰岛素血症合并期间，运动对患者和对照组个体的胰岛素敏感性均无影响。总之，在肝硬化患者中，单次适度运动1）导致底物利用发生转变，运动后脂质氧化增加，且这种增加在患者中比对照组更为显著，2）仅在正常血糖期间增加胰岛素敏感性，而在更接近生理状态的高血糖期间则无此作用。因此单次适度运动可能对慢性肝病患者的代谢状态没有有益影响。
