Ferrando A A, Chinkes D L, Wolf S E, Matin S, Herndon D N, Wolfe R R
Department of Surgery, University of Texas Medical Branch, Galveston, USA.
Ann Surg. 1999 Jan;229(1):11-8. doi: 10.1097/00000658-199901000-00002.
To investigate the hypothesis that a submaximal insulin dose reverses the net muscle catabolism associated with severe burns, and to determine its effects on amino acid kinetics.
The authors previously showed that a maximal dose of insulin administered to patients with severe burns promoted skeletal muscle glucose uptake and net protein synthesis. However, this treatment was associated with caloric overload resulting from the large quantities of exogenous glucose required to maintain euglycemia, and hypoglycemia was a potential problem.
Thirteen patients were studied after severe burn injury (>60% total body surface area). Patients were randomly treated by standard care (n = 5) or with exogenous insulin (n = 8). Data were derived from an arteriovenous model with primed-continuous infusions of stable isotopes and biopsies of the vastus lateralis muscle.
Net amino acid balance was significantly improved with insulin treatment. Skeletal muscle protein synthesis was significantly greater in the group receiving insulin, whereas muscle protein breakdown was not different between the groups. This submaximal dose of insulin did not affect glucose or amino acid uptake or require a greater caloric intake to avoid hypoglycemia.
Submaximal insulin can promote muscle anabolism without eliciting a hypoglycemic response.
探讨次最大剂量胰岛素可逆转与严重烧伤相关的净肌肉分解代谢这一假说，并确定其对氨基酸动力学的影响。
作者之前表明，给严重烧伤患者使用最大剂量胰岛素可促进骨骼肌葡萄糖摄取和净蛋白质合成。然而，这种治疗与维持血糖正常所需大量外源性葡萄糖导致的热量过载相关，且低血糖是一个潜在问题。
对13例严重烧伤（体表面积>60%）患者进行研究。患者被随机分为接受标准治疗组（n = 5）或外源性胰岛素治疗组（n = 8）。数据来自采用稳定同位素首剂持续输注的动静脉模型以及股外侧肌活检。
胰岛素治疗使净氨基酸平衡显著改善。接受胰岛素治疗组的骨骼肌蛋白质合成显著增加，而两组间肌肉蛋白质分解无差异。这种次最大剂量胰岛素不影响葡萄糖或氨基酸摄取，也无需增加热量摄入以避免低血糖。
次最大剂量胰岛素可促进肌肉合成代谢而不引发低血糖反应。
