Insulinresistenz: Bedeutung in Anästhesie und Intensivmedizin – Pathophysiologie der perioperativ gestörten Insulinsensitivität

Zusammenfassung

Hyperglykämie und Insulinresistenz treten gehäuft perioperativ und bei kritisch kranken Patienten auf. Die zugrundeliegende Pathophysiologie ist bislang nur in Ansätzen bekannt, obwohl Hyperglykämien mit erhöhter postoperativer Morbidität und Mortalität assoziiert sind. Die Insulinresistenz ist offenkundig ein komplexes Geschehen, wobei auch gewebsspezifische Unterschiede berücksichtigt werden müssen. Verschiedene Auslöser wie auch unterschiedliche intrazellulär beteiligte Signalkaskaden liegen der perioperativen Insulinresistenz zugrunde. Dieser Review fokussiert auf Mechanismen, welche die klassische Insulinsignalkaskade betreffen.

Abstract

Hyperglycemia and insulin resistance are frequently observed during critical illness. The underlying pathophysiology is not yet fully understood, although hyperglycemia predicts post-surgical morbidity and mortality. Apparently perioperative insulin resistance has a complex pathophysiology and tissue-specific differences have to be considered. Multiple causative factors and intracellular signalling pathways have been identified driving the development of systemic perioperative insulin resistance. This review will focus on mechanisms involving the classical insulin signalling cascade.

Schlüsselwörter:

Perioperative Insulinresistenz - Insulinsignalweg - Critical-Illness

Key words:

perioperative insulin resistance - insulin signalling - critical illness

Kernaussagen

• Bei insulinresistenten Patienten führt eine reduzierte Glukoseaufnahme zu gesteigerter Morbidität und Mortalität.

• Hyperglykämie und Insulinresistenz sind mit erhöhten postoperativen Komplikationen verbunden.

• Physische Inaktivität ist assoziiert mit dem Auftreten von Insulinresistenz und Mikrozirkulationsstörungen.

• Kortisol, Wachstumshormone und endogene wie exogene Katecholaminspiegel hemmen die Wirkung von Insulin.

• Hypocholesterinämie wird bei Verletzungen und Infektionen häufig beobachtet; es besteht eine Korrelation zwischen Hypocholesterinämie und Mortalität.

• Nach Operationen und Verletzungen können erhöhte inflammatorische Zytokinspiegel nachgewiesen werden, welche mit Insulinresistenz, Diabetes-mellitus Typ 2 und Adipositas in Verbindung gebracht werden.

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