左心室辅助装置对心肌能量代谢及胰岛素抵抗的影响

Effect of left ventricular assist device on myocardial energy metabolism and insulin resistance

慢性心力衰竭患者的心肌细胞代谢途径由脂肪酸氧化向糖酵解转换,这种转换是对心肌缺氧的生理适应性反应,同时伴有胰岛素抵抗和生长激素/胰岛素样生长因子-1抵抗,最终出现各种能量代谢障碍。左心室辅助装置(left ventricular assist device,LVAD)是一种新的改善终末期心力衰竭患者生活质量和生存率的治疗方法。大量研究证实,LVAD能够改善心肌细胞能量代谢,上调糖酵解、磷酸戊糖途径和单碳糖代谢途径,减轻氧化应激及炎性反应,改善胰岛素抵抗。LVAD植入初期和远期都能显著改善高血糖患者的血糖水平,但是多数研究显示血糖改善与预后无关,可能需要从单纯控糖转向糖尿病的全面管理。

The metabolic pathway of cardiomyocytes in patients with chronic heart failure is converted from fatty acid oxidation to glycolysis,which is a physiological adaptive response to myocardial hypoxia.This transition is accompanied by insulin resistance,which lead to various energy metabolic disorders eventually.Left ventricular assist device(LVAD)is a new treatment method that improves the quality of life and survival rate in patient with end-stage heart failure.A large number of studies have confirmed that LVAD can improve energy metabolism and up-regulate glycolysis,pentose phosphate pathway and single carbon sugar metabolism pathway in cardiomyocyte.Further more,LVAD can improve insulin resistance through reducing oxidative stress and inflammation.LVAD implantation can significantly improve the blood glucose control among hyperglycemia patients in both the initial and long term stage.However,most studies showed the improvement in blood glucose control did not related with the prognosis.It may indicate the necessary of shifting from simple glucose control to comprehensive management of diabetes.