烧伤创面修复中的代谢问题及营养策略

彭曦; 孙勇

doi:10.3760/cma.j.cn501225-20220708-00288

烧伤创面修复中的代谢问题及营养策略

doi: 10.3760/cma.j.cn501225-20220708-00288

彭曦^1, ,,
孙勇²

1.
陆军军医大学（第三军医大学）第一附属医院临床医学研究中心，全军烧伤研究所，创伤、烧伤与复合伤国家重点实验室，重庆　　400038
2.
徐州医科大学附属淮海医院　　陆军第七十一集团军医院烧伤整形科，徐州　　221004

基金项目:

国家自然科学基金面上项目 82172202

重庆英才创新领军人才项目 cstc2022ycjh-bgzxm0148

详细信息

通讯作者:
彭曦，Email：pxlrmm@163.com

计量
- 文章访问数: 3575
- HTML全文浏览量: 56
- PDF下载量: 63
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-08

Metabolic issues and nutritional strategies in burn wound repair

Peng Xi^{1
, ,},
Sun Yong²

1.
Clinical Medical Research Center, Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China
2.
Department of Burns and Plastic Surgery, the 71st Group Army Hospital of Army, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou 221004, China

Funds:

General Program of National Natural Science Foundation of China 82172202

Innovative Leading Talents Project of Chongqing cstc2022ycjh-bgzxm0148

More Information

Corresponding author: Peng Xi, Email: pxlrmm@163.com

摘要

摘要: 创面是烧伤最根本的问题，其修复不仅依赖有效的创面处理，还依赖患者良好的营养状态。营养支持是改善患者营养状况、促进创面愈合的重要手段，如何使之与烧伤创面的代谢相匹配是营养治疗的难点。该文从分析烧伤创面愈合中不同阶段的代谢特征入手，着重论述了葡萄糖、蛋白质与谷氨酰胺在这些阶段的代谢特点，提出了与创面愈合相适应的营养策略，以期最大限度地发挥营养治疗在创面修复中的作用。
- 烧伤 /
- 代谢 /
- 营养疗法 /
- 创面修复
Abstract: Wound is the most fundamental issue of burn injury, and its repair depends not only on effective wound treatment, but also on the good nutritional status of burned patients. Nutrition support is an important means to improve the nutritional status of patients and promote wound healing, and how to make it match the metabolism of burn wounds is a difficult task of nutrition therapy. In this paper, we analyzed the metabolic characteristics of different stages in burn wound healing, focused on the metabolic characteristics of glucose, protein, and glutamine in these stages, and proposed a nutritional strategy that is compatible with wound healing in order to maximize the role of nutrition therapy in wound repair.
- Burns /
- Metabolism /
- Nutrition therapy /
- Wound healing
所有作者均声明不存在利益冲突

HTML全文

下载: 全尺寸图片幻灯片

参考文献(50)

[1]	许伟石, 刘琰, 乐嘉芬. 烧伤创面修复[M].2版.武汉:湖北科学技术出版社, 2013: 36-66.
[2]	AbazariM, GhaffariA, RashidzadehH, et al. A systematic review on classification, identification, and healing process of burn wound healing[J]. Int J Low Extrem Wounds, 2022, 21(1): 18-30. DOI: 10.1177/1534734620924857.
[3]	杨宗城. 烧伤治疗学[M].3版.北京: 人民卫生出版社, 2006: 180-211.
[4]	ClarkA, ImranJ, MadniT, et al. Nutrition and metabolism in burn patients[J/OL]. Burns Trauma, 2017,5:11[2022-07-20]. https://pubmed.ncbi.nlm.nih.gov/28428966/. DOI: 10.1186/s41038-017-0076-x.
[5]	YarmushML, GolbergA. Bioengineering in wound healing: a systems approach[M]. New Jersey: World Scientific, 2017: 135-168.
[6]	Arribas-LópezE, ZandN, OjoO, et al. The effect of amino acids on wound healing: a systematic review and meta-analysis on arginine and glutamine[J]. Nutrients, 2021, 13: 2498. DOI: 10.3390/nu13082498.
[7]	ČomaM, FröhlichováL, UrbanL, et al. Molecular changes underlying hypertrophic scarring following burns involve specific deregulations at all wound healing stages (inflammation, proliferation and maturation)[J]. Int J Mol Sci, 2021, 22(2):897.DOI: 10.3390/ijms22020897.
[8]	彭曦. 重症烧伤患者的代谢分期及营养治疗策略[J].中华烧伤杂志,2021,37(9):805-810. DOI: 10.3760/cma.j.cn501120-20210802-00264.
[9]	VinaikR, BarayanD, AugerC, et al. Regulation of glycolysis and the Warburg effect in wound healing[J]. JCI Insight, 2020, 5(17):e138949. DOI: 10.1172/jci.insight.138949.
[10]	LiB, TangH, BianX, et al. Calcium silicate accelerates cutaneous wound healing with enhanced re-epithelialization through EGF/EGFR/ERK-mediated promotion of epidermal stem cell functions[J/OL]. Burns Trauma, 2021,9:tkab029[2022-07-20]. https://pubmed.ncbi.nlm.nih.gov/34604395/. DOI: 10.1093/burnst/tkab029.
[11]	WangCG, LouYT, TongMJ, et al. Asperosaponin Ⅵ promotes angiogenesis and accelerates wound healing in rats via up-regulating HIF-1α/VEGF signaling[J]. Acta Pharmacol Sin, 2018,39(3):393-404. DOI: 10.1038/aps.2017.161.
[12]	RussoTA, BanuthA, NaderHB, et al. Altered shear stress on endothelial cells leads to remodeling of extracellular matrix and induction of angiogenesis[J]. PLoS One, 2020,15(11):e0241040. DOI: 10.1371/journal.pone.0241040.
[13]	YingM, YouD, ZhuX, et al. Lactate and glutamine support NADPH generation in cancer cells under glucose deprived conditions[J]. Redox Biol, 2021,46:102065. DOI: 10.1016/j.redox.2021.102065.
[14]	ChenL, ZhangZ, HoshinoA, et al. NADPH production by the oxidative pentose-phosphate pathway supports folate metabolism[J]. Nat Metab, 2019,1:404-415.
[15]	SwamyM, PathakS, GrzesKM, et al. Glucose and glutamine fuel protein O-GlcNAcylation to control T cell self-renewal and malignancy[J]. Nat Immunol, 2016,17(6):712-720. DOI: 10.1038/ni.3439.
[16]	HewitsonTD, SmithER. A metabolic reprogramming of glycolysis and glutamine metabolism is a requisite for renal fibrogenesis-why and how?[J]. Front Physiol, 2021,12:645857. DOI: 10.3389/fphys.2021.645857.
[17]	PorterC, TompkinsRG, FinnertyCC, et al. The metabolic stress response to burn trauma: current understanding and therapies[J]. Lancet, 2016,388(10052):1417-1426. DOI: 10.1016/S0140-6736(16)31469-6.
[18]	孙勇, 彭曦. 重视烧伤创面愈合中的蛋白质营养问题[J]. 肠外与肠内营养, 2022, 29(2): 65-68. DOI: 10.16151/j.1007-810x.2022.02.001.
[19]	AltmanBJ, StineZE, DangCV. From Krebs to clinic: glutamine metabolism to cancer therapy[J]. Nat Rev Cancer, 2016,16(10):619-634. DOI: 10.1038/nrc.2016.71.
[20]	ScaliseM, PochiniL, GalluccioM, et al. Glutamine transport. From energy supply to sensing and beyond[J]. Biochim Biophys Acta, 2016,1857(8):1147-1157. DOI: 10.1016/j.bbabio.2016.03.006.
[21]	ScaliseM, PochiniL, GalluccioM, et al. Glutamine transport and mitochondrial metabolism in cancer cell growth[J]. Front Oncol, 2017,7:306. DOI: 10.3389/fonc.2017.00306.
[22]	KimJS, MartinMJ. REDOX REDUX? glutamine, catabolism, and the urea-to-creatinine ratio as a novel nutritional metric[J]. Crit Care Med, 2022,50(7):1156-1159. DOI: 10.1097/CCM.0000000000005520.
[23]	GongJ, JingL. Glutamine induces heat shock protein 70 expression via O-GlcNAc modification and subsequent increased expression and transcriptional activity of heat shock factor-1[J]. Minerva Anestesiol, 2011,77(5):488-495.
[24]	ZhouT, YangY, ChenQ, et al. Glutamine metabolism is essential for stemness of bone marrow mesenchymal stem cells and bone homeostasis[J]. Stem Cells Int, 2019,2019:8928934. DOI: 10.1155/2019/8928934.
[25]	NelsonVL, NguyenH, Garcìa-CañaverasJC, et al. PPARγ is a nexus controlling alternative activation of macrophages via glutamine metabolism[J]. Genes Dev, 2018,32(15/16):1035-1044. DOI: 10.1101/gad.312355.118.
[26]	LiuPS, WangH, LiX, et al. α-ketoglutarate orchestrates macrophage activation through metabolic and epigenetic reprogramming[J]. Nat Immunol, 2017,18(9):985-994. DOI: 10.1038/ni.3796.
[27]	YangYJ, LiuMM, ZhangY, et al. Effectiveness and mechanism study of glutamine on alleviating hypermetabolism in burned rats[J]. Nutrition, 2020,79-80:110934. DOI: 10.1016/j.nut.2020.110934.
[28]	KimCS, DingX, AllmerothK, et al. Glutamine metabolism controls stem cell fate reversibility and long-term maintenance in the hair follicle[J]. Cell Metab, 2020,32(4):629-642.e8. DOI: 10.1016/j.cmet.2020.08.011.
[29]	YooHC, YuYC, SungY, et al. Glutamine reliance in cell metabolism[J]. Exp Mol Med, 2020,52(9):1496-1516. DOI: 10.1038/s12276-020-00504-8.
[30]	LiuJ, MarchaseRB, ChathamJC. Glutamine-induced protection of isolated rat heart from ischemia/reperfusion injury is mediated via the hexosamine biosynthesis pathway and increased protein O-GlcNAc levels[J]. J Mol Cell Cardiol, 2007,42(1):177-185. DOI: 10.1016/j.yjmcc.2006.09.015.
[31]	RaoX, DuanX, MaoW, et al. O-GlcNAcylation of G6PD promotes the pentose phosphate pathway and tumor growth[J]. Nat Commun, 2015,6:8468. DOI: 10.1038/ncomms9468.
[32]	KielerM, HofmannM, SchabbauerG. More than just protein building blocks: how amino acids and related metabolic pathways fuel macrophage polarization[J]. FEBS J, 2021, 288(12): 3694-3714. DOI: 10.1111/febs.15715
[33]	ShahAM, WangZ, MaJ. Glutamine metabolism and its role in immunity, a comprehensive review[J]. Animals (Basel), 2020, 10(2):326. DOI: 10.3390/ani10020326.
[34]	SunS, LiH, ChenJ, et al. Lactic acid: no longer an inert and end-product of glycolysis[J]. Physiology (Bethesda), 2017,32(6):453-463. DOI: 10.1152/physiol.00016.2017.
[35]	彭曦. 烧伤临床营养新视角[J].中华烧伤杂志,2019,35(5):321-325. DOI: 10.3760/cma.j.issn.1009-2587.2019.05.001.
[36]	HewJJ, ParungaoRJ, MooneyCP, et al. Low-protein diet accelerates wound healing in mice post-acute injury[J/OL]. Burns Trauma, 2021,9:tkab010[2022-07-20]. https://pubmed.ncbi.nlm.nih.gov/34377708/. DOI: 10.1093/burnst/tkab010.
[37]	HoltB, GravesC, FaraklasI, et al. Compliance with nutrition support guidelines in acutely burned patients[J]. Burns, 2012,38(5):645-649. DOI: 10.1016/j.burns.2011.12.002.
[38]	RousseauAF, LosserMR, IchaiC, et al. ESPEN endorsed recommendations: nutritional therapy in major burns[J]. Clin Nutr, 2013,32(4):497-502. DOI: 10.1016/j.clnu.2013.02.012.
[39]	彭曦. 重视谷氨酰胺在烧伤临床的规范应用[J].肠外与肠内营养,2021,28(1):1-4. DOI: 10.16151/j.1007-810x.2021.01.001.
[40]	KaufmanT, LevinM, HurwitzDJ. The effect of topical hyperalimentation on wound healing rate and granulation tissue formation of experimental deep second degree burns in guinea-pigs[J]. Burns Incl Therm Inj, 1984,10(4):252-256. DOI: 10.1016/0305-4179(84)90003-2.
[41]	ViljantoJ, RaekallioJ. Local hyperalimentation of open wounds[J]. Br J Surg, 1976,63(6):427-430. DOI: 10.1002/bjs.1800630603.
[42]	BergerMM, BinzPA, RouxC, et al. Exudative glutamine losses contribute to high needs after burn injury[J]. JPEN J Parenter Enteral Nutr, 2022,46(4):782-788. DOI: 10.1002/jpen.2227.
[43]	JafariP, ThomasA, HaselbachD, et al. Trace element intakes should be revisited in burn nutrition protocols: a cohort study[J]. Clin Nutr, 2018,37(3):958-964. DOI: 10.1016/j.clnu.2017.03.028.
[44]	WilgusTA, DiPietroLA. Complex roles for VEGF in dermal wound healing[J]. J Invest Dermatol, 2012,132(2):493-494. DOI: 10.1038/jid.2011.343.
[45]	肖健, 张凡. 生长因子调控创面修复的进展与思考[J]. 中华烧伤与创面修复杂志, 2022, 38(7):610-615. DOI: 10.3760/cma.j.cn501225-20220416-00139.
[46]	吴炜, 彭曦. 肠道谷氨酰胺转运载体研究进展[J].中华烧伤杂志,2014,30(2):171-174. DOI: 10.3760/cma.j.issn.1009-2587.2014.02.017.
[47]	中华医学会烧伤外科学分会,《中华烧伤杂志》编辑委员会. 皮肤创面外用生长因子的临床指南[J].中华烧伤杂志,2017,33(12):721-727. DOI: 10.3760/cma.j.issn.1009-2587.2017.12.001.
[48]	HanCM, ChengB, WuP. Clinical guideline on topical growth factors for skin wounds[J]. Burns Trauma, 2020,8:tkaa035[2022-07-20]. https://pubmed.ncbi.nlm.nih.gov/33015207/. DOI: 10.1093/burnst/tkaa035.
[49]	LiQ, ZhongX, YaoW, et al. Inhibitor of glutamine metabolism V9302 promotes ROS-induced autophagic degradation of B7H3 to enhance antitumor immunity[J]. J Biol Chem, 2022,298(4):101753. DOI: 10.1016/j.jbc.2022.101753.
[50]	LiL, MengY, LiZ, et al. Discovery and development of small molecule modulators targeting glutamine metabolism[J]. Eur J Med Chem, 2019,163:215-242. DOI: 10.1016/j.ejmech.2018.11.066.