慢性心力衰竭和 2 型糖尿病患者体内的循环支链氨基酸

Kozhevnikova M.V., Zektser V.Yu., Petrukhnova M.F., Krivova A.V., Appolonova S.A.
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摘要

慢性心力衰竭(CHF)问题的重要性无论怎样估计都不为过:全世界有数百万患者被诊断出患有这种综合征,而且发病率还在不断上升。患有碳水化合物代谢紊乱(CMD)的患者比例也在稳步上升。碳水化合物代谢紊乱与慢性心力衰竭的进展密切相关,因此这类患者被划分为一个独立的表型群--"慢性心力衰竭的代谢表型"。慢性心力衰竭代谢表型 "的病理生理学基础是严重的代谢紊乱,这决定了该类患者代谢组的特征。因此,这项工作的目的是比较和评估在机体代谢过程中占据最重要位置之一的代谢物--支链氨基酸(BCAA)水平与慢性心力衰竭患者表型特征之间的关系。这项研究包括 218 名患者:主要组中有 133 名患有慢性阻塞性肺疾病的慢性阻塞性肺疾病患者;对比组中有 85 名患有慢性阻塞性肺疾病的慢性阻塞性肺疾病患者,无慢性阻塞性肺疾病。两组患者的性别(P=0,324)和年龄(P=0,936)具有可比性。患者血浆中的 BCAAs(亮氨酸、异亮氨酸和缬氨酸)水平通过高效液相色谱结合质谱法(HPLC-MS)进行了评估。根据分析结果,得出了以下数据:CHF 和 CMD 患者血浆中的缬氨酸和亮氨酸水平(p=0,022 和 p<0,001)高于 CHF 和碳水化合物代谢正常的患者。研究发现,亮氨酸+异亮氨酸水平与葡萄糖浓度之间存在直接关系(r=0,3,p<0,001),缬氨酸血浆浓度与钠利尿激素 N 端前肽(NTproBNP)水平之间存在反向关系(r=-0,388,p<0,001)。已经证实,患者组织胰岛素抵抗水平高与 BCAA 浓度增加有关。这些结果表明,BCAA 在 "慢性心力衰竭代谢表型 "的发病机制中发挥着重要作用,需要在此方向上开展进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CIRCULATING BRANCHED CHAIN AMINO ACIDS IN PATIENTS WITH CHRONIC HEART FAILURE AND TYPE 2 DIABETES MELLITUS
The importance of the problem of chronic heart failure (CHF) is hard to overestimate: this syndrome is diagnosed in millions of patients around the world and its prevalence continues to grow. The proportion of patients suffering from carbohydrate metabolism disorders (CMD) is also steadily increasing. The close connection between carbohydrate metabolism disorders and the progression of CHF allowed such patients to be classified into a separate phenotype cluster - the “metabolic phenotype of CHF”. The pathophysiology of the “metabolic phenotype of CHF” is based on significant metabolic disorders, which determines the characteristic features of the metabolome of this cohort of patients. Therefore, the purpose of this work is to compare and evaluate the relationship between metabolites that occupy one of the most important places in the metabolic processes of the body - the levels of branched chain amino acids (BCAA) and the phenotypic characteristics of patients with CHF. The study included 218 patients: 133 patients of the main group suffering from CHF and having CMD; comparison group - 85 patients with CHF without CMD. The groups were comparable by gender (p=0,324) and age (p=0,936). The levels of BCAAs - leucine, isoleucine, valine - in the blood plasma of patients were assessed by high-performance liquid chromatography combined with mass spectrometry (HPLC-MS). Based on the results of the analysis, the following data were obtained: plasma levels of valine and leucine in patients with CHF and CMD were higher (p=0,022 and p<0,001, respectively) than in patients with CHF and normal carbohydrate metabolism. A direct relationship between the level of leucine + isoleucine and the concentration of glucose (r=0,3, p<0,001) and an inverse relationship between the plasma concentration of valine and the level of N-terminal propeptide of natriuretic hormone (NTproBNP) (r=-0,388, p<0,001) were found. It has been established that a high level of tissue insulin resistance in patients is associated with increased concentrations of BCAA. The results indicate the important role of BCAA in the pathogenesis of the “metabolic phenotype of CHF,” which requires further research in this direction.
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