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首页 > 医学词汇大全 > Lactic acidosis
Lactic acidosis

内分泌

关键词内分泌 疾病 代谢性酸中毒

词汇介绍

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解析

lactic   英 /'læktɪk/   美 /'læktɪk/

释    义   adj. 乳的;乳汁的

例    句   The somewhat acid flavour is caused by the presence of lactic acid. 这种微酸的味道是因为含有乳酸造成的。

 

acidosis   英 /,æsɪ'dəʊsɪs/   美 /,æsɪ'dosɪs/

释    义   n. [内科] 酸中毒,酸毒症;酸液过多症

例    句   Shock , sepsis, acidosis , hypoxia, and so forth, are treated. 对休克,感染,酸中毒,缺氧等应加以治疗。

概述

乳酸性酸中毒是代谢性酸中毒的一种形式,原因是一个人生产过多或未充分利用乳酸,但是他们的身体对乳酸这样的变化却无法适应。乳酸性酸中毒的人的肝脏(有时是肾脏)能够从体内清除多余的酸。如果乳酸在体内积累的速度快于其被清除的速度,那么体液(例如血液)中的酸度水平就会飙升。这种酸的积累会导致人体的pH值失衡,应该始终是弱碱性而不是酸性。有几种不同类型的酸中毒。当肌肉中的氧气不足以分解葡萄糖和糖原时,就会发生乳酸堆积。这称为无氧代谢。乳酸有两种:L-乳酸和D-乳酸。病理原因①心脏病:诸如心脏疾病和充血性

Metformin-related lactic acidosis with acute kidney injury: results of a French observational multicenter study复制标题

二甲双胍相关乳酸酸中毒伴急性肾损伤: 一项法国观察性多中心研究结果

发表时间:2019-08-06

影响因子:4.4

作者: Anthony Corchia

期刊:Clin Toxicol

Our study highlights the different mortality rate between MALA and MILA, despite a severe acid–base imbalance in the entire population. We found that shock was strongly associated with death, whereas exposure to RAAS inhibitors surprisingly seemed to have a mild protective effect. Hypotension induced by RAAS inhibitors is generally reversed by intravenous fluid administration. Furthermore, RAAS inhibitors improve left ventricular function in chronic heart failure, reducing cardiac afterload. This may explain their protective effect during shock, especially in MILA. Seventy-five percent of our patients with shock and MALA had septic shock, a condition that was strongly associated with death (data not shown). The assertion that outcome is correlated with lactate levels or pH has yet to be proven. In our cohort, neither lactate levels nor metformin levels were directly associated with death. Selecting a subgroup of 56 cases of severe MALA (pH 10 mmol/L), Kajbaf and Lalau  did not confirm this relationship at this level of severity. On the contrary, nadir serum pH, peak serum lactate and metformin concentration were found to be associated with mortality in a systematic review of literature. In our study, metformin level was correlated with lactate level and pH only in MILA (Supplemental Figure S1). Interestingly, there was no correlation in MALA, where LA was mainly influenced by the concurrence of multiple risk factors. This confirms the interest of our approach separating LA according to different situations in a context of metformin exposure. Our study underlines the role of metformin in MILA and refutes arguments that call this pathology into question. MILA is theoretically defined by an increased metformin concentration. We reported 13 patients with a plasma metformin level under 5 mg/L, but we cannot exclude the possibility that this may reflect delayed diagnosis. The time since the last metformin intake was unknown which complicates the interpretation of the plasma level of metformin. Furthermore, exposure to high metformin concentrations may have prolonged effects on oxidative metabolism even after a lengthy washout. The measurement of metformin concentration should be performed as soon as possible even if the results are not immediately available.

译文

尽管整个人群中酸碱失衡严重,但我们的研究强调了MALA和MILA之间的死亡率不同。我们发现,休克与死亡密切相关,而意外接触RAAS抑制剂似乎具有轻度的保护作用。通常通过静脉内输液逆转由RAAS抑制剂引起的低血压。此外,RAAS抑制剂可改善慢性心力衰竭患者的左心室功能,减少心脏后负荷。这可以解释它们在电击期间的保护作用,尤其是在MILA中。在我们的休克和MALA患者中,有75%患有败血性休克,这种状况与死亡密切相关(数据未显示)。关于结果与乳酸水平或pH相关的说法尚未得到证实。在我们的队列中,乳酸水平和二甲双胍水平都不与死亡直接相关。 Kajbaf和Lalau选择了56例重度MALA(pH 10 mmol / L)的亚组,但在此严重性水平上并未证实这种关系。相反,在系统的文献综述中,发现最低血清pH,峰值乳酸盐和二甲双胍浓度与死亡率相关。在我们的研究中,仅在MILA中,二甲双胍水平与乳酸水平和pH相关(补充图S1)。有趣的是,MALA中没有相关性,其中LA主要受多种风险因素的并发影响。这证实了我们在二甲双胍暴露的情况下根据不同情况分离LA的方法的兴趣。我们的研究强调了二甲双胍在MILA中的作用,并驳斥了将这种病理学质疑的论点。从理论上讲,MILA由二甲双胍浓度的增加来定义。我们报告了13名血浆二甲双胍水平低于5 mg / L的患者,但我们不能排除这可能反映诊断延迟的可能性。自上次服用二甲双胍以来的时间未知,这使对二甲双胍血浆水平的解释变得复杂。此外,即使经过长时间冲洗,暴露于高浓度的二甲双胍也可能对氧化代谢产生延长的影响。即使无法立即获得结果,二甲双胍浓度的测量也应尽快进行。