上腹部手术病人围术期红细胞内HK、PFK和G-6PD酶活性的变化

Perioperative changes of erythrocytes hexokinase, phosphofructokinase and glucose-6-phasphate dehydrogenase activities in patients undergoing upper abdominal surgery

目的 探讨磷酸戊糖途径在上腹部术后糖酵解酶活性下降中的作用及其机制。方法 2 6例择期上腹部手术病人随机分成三组 :硬膜外阻滞 (EB)组 (10例 ) ,异丙酚静脉麻醉 (PRO)组 (10例 )和静脉普鲁卡因复合麻醉 (IPBA)组 (6例 )。于麻醉前、手术 6 0min、术后 6 0min、术后第 1d和第 2d5个时点取静脉血 ,同步测定血糖和红细胞内己糖激酶 (HK)、磷酸果糖激酶 (PFK)及 6 磷酸葡萄糖脱氢酶(G 6PD)活性。结果 术后第 1d各组HK、PFK活性均明显下降 (P <0 0 5或P <0 0 1)。术后第 1d各组G 6PD活性均明显上升 (P均 <0 0 5 )。上述酶活性于术后第 2d基本恢复正常 ,但术后第 2dIPBA组的G 6PD活性仍高于PRO组 (P <0 0 5 )。术后 6 0min和第 1d、第 2d血糖值明显高于麻醉前值 (P <0 0 5或P <0 0 1)。结论 术后高血糖状态下 ,红细胞HK、PFK活性明显下降 ,而G 6PD活性升高 ,提示糖酵解通路受抑制的同时磷酸戊糖通路活跃 ,有利于抗氧化应激损伤和代偿性地增加葡萄糖的分解去路。

Objective To investigate the role of pentose phosphate pathway (PPP) after upper abdominal operationMethods Twenty-six patients undergoing upper abdominal surgery, were divided randomly into three groups: epidural block(EB,n=10), intravenous propofol anesthesia(PRO, n=10) and intravenous procaine balanced anesthesia(IPBA,n=6) The venous blood samples were collected to measure of erythrocytes hexokinase (HK), phosphofructokinase (PFK) and glucose-6-phasphate dehydrogenase (G-6PD), and activities, and plasma glucose before anesthesia induction, 60 min after incision,60 min after surgery, on the 1st and 2nd postoperative daysResults Compared with the values before anesthesia, the activities of erythrocyte HK and PFK decreased significantly on the 1st postoperative day in three groups (P<005 or 001) The activities of both enzymes almost returned to the baselines on the 2nd postoperative day in three groups Erythrocyte G-6PD activity increased on the 1st postoperative day compared with that before anesthesia in all three groups (P<005 or 001) and returned to the baselines on the 2nd postoperative day, but compared with that of PRO, the G-6PD activity in IPBA increased on the 2nd postoperative day (P<005) The plasma glucose level was higher 60 min after operation and on the 1st or 2nd postoperative day than the baselines (P<005 or 001)Conclusions The pentose phosphorate pathway is active when the glycolysis is depressed after operation, which may be of benefit to the reduction in oxidative damages and compensatory increase in glucose matabolism