胃癌手术干预患者血液中维生素B1生物功能的实现

N. N. Kostenevich, I. P. Chernikevich, V. V. Baum, V. A. Malashenko
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引用次数: 0

摘要

背景接受手术的概率总是预先决定一个人的压力状态;因此,寻求优化和(或)减少这种不利影响的方法是可取的。客观的探讨维生素B1在外科手术中抗应激作用的机制。材料和方法。对捐赠者的血液裂解物(n=19)和接受择期手术的癌症III期患者(n=64)(年龄51-70岁)进行了代谢强度调查。在手术前三天、术前、手术最痛苦的时刻、拔管后以及术后第一天和第三天从肘静脉采血。手术在复合多组分麻醉下进行,使用一氧化氮、羟丁酸钠和硬膜外阻滞。硫胺素和硫胺素二磷酸激酶活性通过形成的维生素的硫胺素双磷酸盐和三磷酸盐的浓度来评估。通过释放无机磷酸盐来测定硫胺素一磷酸、二磷酸和三磷酸的活性。用色度法记录无机磷酸盐的浓度。采用离子对反相高效液相色谱法测定血液中B1及其衍生物的含量。后果已经观察到,在癌症捐赠者和患者的血液中,一磷酸硫胺素和游离硫胺素的含量增加。水解硫胺素单磷酸酶反应的记录速率不高。在用药前和手术暴露的最大创伤阶段,单磷酸酯的浓度随着单磷酸酶的激活而迅速降低。因此,硫胺素一磷酸水解是维生素B1代谢的限速环节。游离硫胺素的水平在手术治疗的所有阶段都持续增加。硫胺素单磷酸酶活性在两个最适pH值(6.0和9.0)下表现出来。在pH为9.0时,硫胺素一磷酸的水解是由碱性磷酸酶催化的。在pH为6.0时,除了硫胺素单磷酸酯外,该酶只水解对硝基苯基磷酸酯、黄素单核苷酸和磷酸酪氨酸,这使其被归类为肝酸性磷酸酶。压力下B1代谢的显著变化主要涉及非辅酶形式——硫胺素单、三磷酸和游离硫胺素,它们在硫醇还原阶段用作胰岛素合成的重要成分。结论。维生素B1的使用允许在外科治疗的所有阶段优化应激反应的发展。它的保护作用是通过激活胰腺的胰岛素合成功能来实现的,从而提高血液中免疫反应性胰岛素的水平。胰岛素合成最有利的生理条件的形成提供了游离硫胺素的增加背景,这是由于维生素的非酶形式的水解而产生的。硫胺素代谢与B2交换和细胞内信号通路调节之间的关系已被追踪。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
VITAMIN B1 BIOLOGICAL FUNCTION IMPLEMENTATION IN THE BLOOD OF PATIENTS WITH STOMACH CANCER UNDER SURGICAL INTERVENTION
Background. The probability of undergoing surgery always predetermines the state of stress in a person; therefore, it is advisable to search for ways to optimize and (or) reduce this unfavourable effect. Objective. To find out the mechanism of vitamin B1 antistress activity during surgery. Material and methods. Metabolism intensity was investigated on donors’ blood lysates (n = 19) and those of patients with stage III stomach cancer (n = 64), referred to an elective surgery, aged 51-70. The blood was taken from the cubital vein three days before the operation, after premedication, during the most traumatic moment of the operation, after extubation, as well as on the first and third days of the postoperative period. The surgery was performed under combined multicomponent anesthesia using nitric oxide, sodium hydroxybutyrate, and epidural block. Thiamine and thiamine diphosphate kinase activities were assessed by the concentration of the formed thiamine di- and triphosphates of the vitamin. The activities of thiamine mono-, di- and triphosphatases were determined by the release of inorganic phosphate. The concentration of inorganic phosphate was recorded colorimetrically. The content of B1 and its derivatives in the blood was determined by the method of ion-pair reversed-phase HPLC. Results. There has been observed an increased content of thiamine monophosphate and that of free thiamine in the blood of donors and patients with stomach cancer. The registered rate of the hydrolytic thiamine monophosphatase reaction is not high. At the stages of premedication and maximum trauma of surgical exposure, the concentration of monophosphoric ester rapidly decreases alongside with monophosphatase activation. Therefore, the thiamine monophosphate hydrolysis is the rate-limiting link of vitamin B1 metabolism. The level of free thiamine remains persistently increased at all stages of surgical treatment. Thiamine monophosphatase activity is manifested at two pH optima – of 6.0 and 9.0. Thiamine monophosphate hydrolysis at pH of 9.0 is catalyzed by alkaline phosphatase. At pH of 6.0, in addition to thiamine monophosphoric ester, the enzyme hydrolyzes only p-nitrophenyl phosphate, flavin mononucleotide and phosphotyrosine, that allows it to be classified as hepatic acid phosphatase. The noted changes in B1 metabolism under stress concern mainly non-coenzyme forms - thiamine mono-, triphosphate, and free thiamine, which are used at the stages of thiol reduction as important components of insulin synthesis. Conclusions. The use of vitamin B1 allows to optimize the development of the stress response at all stages of surgical treatment. Its protective effect is achieved through the activation of the insulin-synthetic function of the pancreas, which increases the level of immunoreactive insulin in the blood. The formation of the most favorable physiological conditions for insulin synthesis provides an increased background of free thiamine, which is created due to the hydrolysis of noncoenzyme forms of the vitamin. The relationship between thiamine metabolism and B2 exchange and regulation of intracellular signaling pathways has been traced.
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