在严重肝功能障碍的情况下柠檬酸代谢的诱导代谢途径：事实还是虚构？,Critical Care

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在严重肝功能障碍的情况下柠檬酸代谢的诱导代谢途径：事实还是虚构？
Critical Care ( IF 8.8 ) Pub Date : 2019-05-14 , DOI: 10.1186/s13054-019-2432-7
Patrick M Honore ₁ , David De Bels ₁ , Sebastien Redant ₁ , Rachid Attou ₁ , Luc Kugener ₁ , Willem Boer ₂

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我们带着兴趣阅读了 Klingele 等人发表的论文。[1] 在最近一期的重症监护中。由于柠檬酸盐代谢通过柠檬酸循环依赖于氧气，因此主要发生在具有大量线粒体的器官中，例如肝脏、肾脏或肌肉 [1]，他们假设在肝脏外必须有足够的柠檬酸盐代谢，暗示一个可诱导的代谢途径。他们假设微血管循环紊乱会导致肝功能改变，从而导致肝功能受损和柠檬酸盐积聚。在患有线粒体细胞病 [2] 的新生儿中，柠檬酸循环不能正常运作，因此禁止使用柠檬酸盐进行抗凝。我们报告了两例患有线粒体细胞病的新生儿，其中因出血并发症而停止使用普通肝素。没有抗凝的回路半衰期很短（8 小时）。为了解决这个问题，决定缓慢但渐进地引入柠檬酸盐，增加剂量，每 2 小时监测一次积累。96 小时后，尽管柠檬酸循环功能障碍，这两名新生儿仍能够代谢柠檬酸盐，推断诱导途径被激活。众所周知，在所有细胞中，柠檬酸盐都可以在 Cori 循环（三羧酸循环）内代谢 [1]。它描述了相关的代谢途径，通过这些途径增加剂量，每 2 小时监测一次蓄积。96 小时后，尽管柠檬酸循环功能障碍，这两名新生儿仍能够代谢柠檬酸盐，推断诱导途径被激活。众所周知，在所有细胞中，柠檬酸盐都可以在 Cori 循环（三羧酸循环）内代谢 [1]。它描述了相关的代谢途径，通过这些途径增加剂量，每 2 小时监测一次蓄积。96 小时后，尽管柠檬酸循环功能障碍，这两名新生儿仍能够代谢柠檬酸盐，推断诱导途径被激活。众所周知，在所有细胞中，柠檬酸盐都可以在 Cori 循环（三羧酸循环）内代谢 [1]。它描述了相关的代谢途径，通过这些途径

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Inducible metabolic pathway for citrate metabolism in case of major liver dysfunction: fact or fiction?

With interest, we read the paper published by Klingele et al. [1] in a recent issue of critical care. Because citrate metabolism is oxygen dependent via the citric acid cycle and therefore mainly takes place in organs with high amounts of mitochondria, such as the liver, kidney, or muscle [1], they hypothesized that adequate citrate metabolism must be possible outside the liver, implying an inducible metabolic pathway. They postulate that disturbed microvascular circulation could cause altered hepatic function, resulting in the association of impaired liver function and citrate accumulation. In neonates with mitochondrial cytopathy [2], the citric acid cycle does not function properly and therefore anticoagulation with citrate is contraindicated. We report two cases of neonates suffering from mitochondrial cytopathy in whom unfractionated heparin was stopped because of bleeding complications. Circuit half-lives without anticoagulation were short (8 h). To remedy this, it was decided to introduce citrate slowly but progressively, increasing the dose, monitoring for accumulation every 2 h. After 96 h, the two neonates were able to metabolize citrate despite citric acid cycle dysfunction, inferring activation of the inducible pathway. It is well known that in all cells, citrate can be metabolized within the Cori cycle (tricarboxylic acid cycle) [1]. It describes the linked metabolic pathways by which

更新日期：2019-05-14

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