肝组织的能量不足和数字价值的额外能量。(假设)

E. Galperin
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引用次数: 0

摘要

尽管人们深刻认识到能量供应在生物体绝大多数过程和现象发展中的重要性,但在医学文献中,几乎没有关于严重疾病、创伤性损伤、应激效应和相关治疗中能量需求的概念性研究。提出的假设是基于对文献数据的分析(PubMed关键词:能量不足,应激源,代谢应激,ATP,糖异生,氧化磷酸化,线粒体,胰岛素分泌),重新考虑我们致力于梗阻性黄疸(OJ)中肝组织能量陈述的实验结果,缺血和大面积切除,总结60年的临床,外科和科学活动经验,这使得有可能做出一些需要进一步临床和实验验证的假设。各种病原体(应激源)在体内产生额外的能量,这是代谢反应的能量基础,通过激活先天免疫、全身炎症反应、激活交感神经系统等,确保机体重要功能的适应和消除病原体。额外的能量是对病原体反应的整体强度。这要考虑到压力源的强度和个体身体反应的强度,对于相同强度的压力源,它们可能是不同的。事实上,当应力发展时,它以数字形式确定其强度,即在真实视图中。这一假说的概念来自于这样一个事实,即当身体存在一定程度的能量不足时,压力就会出现,而压力的主要任务是为生物体提供能量。这种程度很少在应激源作用后立即出现。一开始,通常会发生应激前适应反应,这是利用细胞中以ATP和糖原形式储存的能量,也是能量重新分配的结果:在胰岛素依赖性组织中,能量减少,而在包括重要器官在内的胰岛素非依赖性组织中,能量增加。这使得将代谢反应分为两组:pre-stress和stress,并区分两个时期:“pre-stress”和“metabolic stress”成为可能。我们认为,预应激反应也是为了防止代谢应激的发展,代谢应激通过身体组织的蛋白质分解和脂肪分解产生能量。当预应激反应不能满足身体的需要,并出现一定的,以数值表示的能量赤字时,代谢应激就产生了。肝脏在一定程度上反映了机体的代谢状况,肝脏是一个代谢器官,在正常代谢和应激代谢过程中都进行多种反应,产生ATP能量,并兼顾其他器官的代谢状态。肝组织能量不足水平可以作为引起代谢应激形成的一个指标,用数值来评价机体的能量状态,以及机体一般状况的严重程度、有希望的机会、预后和优先治疗,应以全面补充能量不足为目标。在COVID-19严重形式和低血氧饱和度的情况下,这一点尤其重要。在任何压力的影响下,医生必须解决两个问题:处理特定的压力源,并为这种斗争和病人的重要活动提供能量。弥漫性疾病中肝脏功能不全可导致糖异生或葡萄糖氧化磷酸化受损,形成“不成功”或“不完全”应激。
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Energetic insufficiency of liver tissue and additional energy in digital value. (The hypothesis)
Despite the deep understanding of the importance of energy supply in the development of the vast majority of processes and phenomena in organism, there are practically no conceptual researches of energy requirements in severe diseases, traumatic injuries, stressful effects and related treatment in the medical literature.The proposed hypothesis is based on the analysis of literature data (PubMed keywords: energy deficit, stressor, metabolic stress, ATP, gluconeogenesis, oxidative phosphorylation, mitochondria, insulin secretion), reconsideration of the results of our experiments dedicated to the energetic statement of liver tissue in obstructive jaundice (OJ), ischemia and massive resection, summarization of 60 years of experience in clinical, surgical and scientific activities, which made it possible to make a number of assumptions that need further clinical and experimental verification.Various pathogens (stressors) cause the additional energy production in the body, which is the energy basis of metabolic responses that ensure the adaptation of the body's vital functions and the elimination of the pathogen by activation of innate immunity, systemic inflammatory reaction, activation of the sympathetic nervous system, etc.Additional energy is the integral strength of the response to the pathogen, that takes into consideration with the strength of the stressor and the individual strength of the body's response, which can be different for the same strength of the stressor. In fact, when stress develops, it determines its strength in digital form, i.e. in real view.The concept of this hypothesis comes from the fact that stress, which main task is to provide the energy of organism, appears when there is a certain level of energy deficiency in the body.Such level rarely appears immediately after the action of the stressor. At the beginning, pre-stress adaptive reactions usually occur, which use the energy reserve in cells in the form of ATP and glycogen, and are also the result of energy redistribution: a decrease in it in insulin-dependent tissues and an increase in insulin-independent ones, which include vital organs.This made it possible to divide metabolic responses into two groups: pre-stress and stress, and to distinguish two periods: “pre-stress” and “metabolic stress”. Pre-stress reactions, in our opinion, are also aimed at preventing the development of metabolic stress, which generates energy through proteolysis and lipolysis of body tissues. Metabolic stress develops when pre-stress reactions cannot satisfy the needs of the body and a certain, expressed in numerical value, energy deficit occurs. In a certain extent the metabolic situation in the body reflects by the liver, which is a metabolic organ that performs many reactions both during normal and stressful metabolism, generates ATP energy, and takes into account the metabolic state of other organs. The level of energy deficiency of the liver tissue can be an indicator that causes the formation of metabolic stress and evaluates in a numerical value not only the energy position of the body, but also the severity of its general condition, promising opportunities, prognosis and priority treatment, which should be aimed at a comprehensive replenishment of the energy deficit.This is especially important to keep in mind at this time with severe forms of COVID-19 and low blood oxygen saturation. Under any stressful influences, the doctor must solve two problems: to deal with a specific stressor and to provide energy for this struggle and the vital activity of the patient. Functional insufficiency of the liver in its diffuse diseases can lead to impaired gluconeogenesis or oxidative phosphorylation of glucose and the formation of “unsuccessful” or “incomplete” stresses.
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来源期刊
Annals of HPB Surgery
Annals of HPB Surgery Medicine-Gastroenterology
CiteScore
0.70
自引率
0.00%
发文量
41
期刊最新文献
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