ผู้วิจัย
Anurak Ampawan1, Sakchai Sriklang2
บทคัดย่อ
Background: Meƞormin is a common treatment for diabetes, yet it poses a risk of lacac acidosis, especially in paaents with underlying condiaons such as heart failure or liver dysfuncaon. This study invesagates the impact of meƞormin on lactate levels, evaluates its role as a risk factor for lacac acidosis, and examines key paaent characterisacs associated with elevated lactate levels. Subjects and methods: This study was a cross secaonal study at August 15, 2524 to November 15, 2024 of the occurrence of lacac acidosis in paaents treated with meƞormin at Buriram Hospital. The study tracked outcomes from day 0 to day 90, taken with meƞormin Abnormal laboratory values (blood lacac acid, blood bicarbonate, blood acidity and kidney funcƟon. inclusion criteria for the study sample encompassed paaents diagnosed with the following condiaons: insulin-dependent diabetes mellitus with ketoacidosis and Blood oxygen level SpO2 is lower than 95%, And study outcome involved 150 diabeac paaents, whose creaanine, eGFR, and HbA1c levels were measured before and aoer receiving standard treatments, including meƞormin. Lactate levels were assessed using Enzymaac Colorimetric Assay and Biosensor techniques. Blood lactate levels above 4.4 mmol/L were used as a threshold for evaluaang lacac acidosis. And analyze the results using t-test by Stata version 14 program. Results: Paaents receiving meƞormin, especially at doses exceeding 2,550 mg/day, exhibited significantly elevated lactate levels (p < 0.001). Elevated lactate was more prevalent among paaents with specific condiaons, including insulin-dependent diabetes mellitus with ketoacidosis, hypoglycemia, and acute renal failure. Paaents treated with glipizide showed stasacally significant changes in creanine and HbA1c levels (p < 0.05), confirming its impact on these parameters. Conclusion: Elevated lactate levels associated with meƞormin use may indicate a risk of lacac acidosis, paracularly in highrisk parent groups or those receiving high doses. Lactate thresholds of 4.4 mmol/L may serve as a diagnosac criterion for lacac acidosis. Close monitoring and tailored dosing of meƞormin are essenal for minimizing risks.
บรรณานุกรม
1. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S15–33. 2. Hundal RS, Krssak M, Dufour S, Laurent D, Lebon V, Chandramouli V, et al. Mechanism by Metformin Glucose Production in Type 2 Diabetes. Diabetes. 2000 Dec;49(12):2063–9. 3. Suetrong B, Walley KR. Lactic Acidosis in Sepsis: It’s Not All Anaerobic: Implications for Diagnosis and Management. Chest. 2016 Jan;149(1):252–61. 4. Huynh TYL, Oscilowska I, Sáiz J, Nizioł M, Baszanowska W, Barbas C, et al. Metformin and Pentose Phosphate Pathway. Biomolecules. 2021 Dec 15;11(12):1888. 5. Biamonti G, Maita L, Montecucco A. Krebs Cycle. Front Oncol. 2018;8:408. 6. Anderson KA, Madsen AS, Olsen CA, Hirschey MD. Metabolic enzymes NAD+, NADH, or their ratio. Biochim Biophys Acta Bioenerg. 2017 Dec;1858(12):991–8. 7. Beloueche-Babari M, Wantuch S, Casals Galobart T, Koniordou M, , et al. MCT1 Inhibitor AZD3965 s Mitochondrial Metabolism. Cancer Res. 2017 Nov 1;77(21):5913–24. 8. Yu S, Meng S, Xiang M, Ma H. Phosphoenolpyruvate carboxykinase in cell metabolism: Roles and mechanisms beyond gluconeogenesis. Mol Metab. 2021 Nov;53:101257. 9. Zhang Z, Chen L, Liu L, Su X, Rabinowitz J. Chemical Basis for Deuterium Labeling of Fat and NADPH. J Am Chem Soc. 2017 Sep 14;139. 10. Fernie AR, Carrari F, Sweetlove LJ. Respiratory metabolism: glycolysis mitochondrial electron transport. Curr Opin Plant Biol. 2004 Jun;7(3):254–61. 11. Wallace JC, Jitrapakdee S, Chapman-Smith A. Pyruvate carboxylase. Int J Biochem Cell Biol. 1998 Jan;30(1):1–5. 12. Wiese EK, Hitosugi S, Loa ST, Sreedhar A, Andres-Beck LG, Kurmi K, et al. Enzymatic activation of pyruvate kinase. Nat Metab. 2021 Jul;3(7):954–68. 13. Gutman M, Hartstein E. Distinction between NAD- and NADH-binding forms of mitochondrial. Biochim Biophys Acta. 1977 Mar 15;481(1):33–41. 14. Gietl C. Malate dehydrogenase isoenzymes: cellular locations metabolites cytoplasm and cell organelles. Biochim Biophys Acta. 1992 Jun 19;1100(3):217–34. 15. Ruffner HP, Kliewer WM. Phosphoenolpyruvate carboxykinase. Plant Physiol. 1975 Jul;56(1):67–71. 16. Ke X, Xiao H, Peng Y, Wang J, Lv Q, Wang X. Phosphoenolpyruvate. Science. 2022 Dec 2;378(6623):971–7. 17. Kellermann M, Scharte F, Hensel M. Manipulation of Host Cell Organelles by Intracellular Pathogens. Int J Mol Sci. 2021 Jun 17;22(12):6484. 18. Berg JM (Jeremy M, Tymoczko JL, Stryer L, Stryer LB, Biotechnology Information (U.S.). New York : W.H. Freeman ; [Bethesda, MD] NCBI; 2002 [cited 2023 Jul 20]. 1096 p. 19. Thompson RH, Butterfield WJ, Fry IK. Pyruvate metabolism in diabetic neuropathy. Proc R Soc Med. 1960 Feb;53(2):143–6. 20. Chen YJ, Mahieu NG, Huang X, Singh M, Crawford PA, Johnson SL, et al. Lactate metabolism mitochondria. Nat Chem Biol. 2016 Nov;12(11):937–43. 21. Mutimura M, Ebong C, Rao IM, Nsahlai IV. Effect of cutting time on agronomic and nutritional characteristics commercial cultivars. a. Afr J Agric Res. 2017 Aug 31;12(35):2692–703. 22. Chen E, Chen BM, Su YC, Chang YC, Cheng TL, Barenholz Y, et al. Premature Drug Release from Polyethylene Glycol (PEG). ACS Nano. 2020 Jul 28;14(7):7808–22. 23. Ran Z, Wang X, Zhang L, Yang Y, Shang Z, Chen Q, et al. Enzymatic colorimetric method. J Biosci Bioeng. 2023 Sep;136(3):159–65. 24. Bergenstal RM, Mullen DM, Strock E, Johnson ML, Xi MX. Randomized comparison of self-monitored blood glucose (BGM). J Diabetes Complications. 2022 Mar;36(3):108106. 25. Parks SK, Cormerais Y, Pouysségur J. Hypoxia and cellular metabolism in tumour pathophysiology. J Physiol. 2017 Apr 15;595(8):2439–50. 26. Fernie AR, Carrari F, Sweetlove LJ. Respiratory metabolism: glycolysis, the TCA cycle and mitochondrial electron transport. Curr Opin Plant Biol. 2004 Jun;7(3):254–61. 27. Schurr A. Glycolysis of Brain Energy Metabolism. Int J Mol Sci. 2024 Jan 24;25(3):1433. 28. Weinberger J, Klompas M, Rhee C. What Is the Utility of Measuring Lactate Levels in Patients with Sepsis and Septic Shock? Semin Respir Crit Care Med. 2021 Oct;42(5):650–61. 29. Jones AE, Puskarich MA. Sepsis tissue hypoperfusion. Care Clin. 2009 Oct;25(4):769–79, ix. 30. Wellmer A, Prange J, Gerber J, Zysk G, Lange P, Michel U, et al. D- and L-lactate in rabbit and human bacterial meningitis. Scand J Infect Dis. 2001;33(12):909–13. 31. Balamuth F, Scott HF, Weiss SL, Webb M, Chamberlain JM, Bajaj L, et al. Sepsis and Septic Shock. JAMA Pediatr. 2022 Jul 1;176(7):672–8. 32. Read JA, Winter VJ, Eszes CM, Sessions RB, Brady RL. Structural basis for altered activity of M- and H-isozyme lactate dehydrogenase. Proteins. 2001 May 1;43(2):175–85. 33. Macharia JM, Kaposztas Z, Varjas T, Budán F, Zand A, Bodnar I, et al. Targeted lactate dehydrogenase genes Biomed. 2023 Apr;160:114371. 34. Giulieri S, Chapuis-Taillard C, Jaton K, Cometta A, Chuard C, Hugli O, et al. CSF lactate for diagnosis of bacterial meningitis. Microbiol. 2015 Oct;34(10):2049–55. 35. Matoori S, Mooney DJ. Development of a liposomal near-infrared fluorescence lactate assay for human blood. Biomaterials. 2022 Apr;283:121475. 36. Pallotta V, D’Amici GM, D’Alessandro A, Rossetti R, Zolla L. Red blood cell processing for cryopreservation Blood Cells Mol Dis. 2012 Apr 15;48(4):226–32. 37. Amable PR, Carias RBV, Teixeira MVT, da Cruz Pacheco I, Corrêa do Amaral RJF, Granjeiro JM, et al. Platelet-rich plasma preparation for regenerative medicine. 2013 Jun 7;4(3):67. 38. Wacharasint P, Nakada T aki, Boyd JH, Russell JA, Walley KR. Normal-range blood lactate concentration. Shock Augusta Ga. 2012 Jul;38(1):4–10. 39. Okano K, Sato Y, Hama S, Tanaka T, Noda H, Kondo A, et al. l-Lactate oxidase-mediated of l-lactic acid D-lactic acid. Biotechnol J. 2022 Apr;17(4):e2100331. 40. Radziwon-Balicka A, Wiwe EF, Jensen TØ, Nielsen SG, Copois M, Sunde N, et al. blood collection tube for clinical usage. Clin Chim Acta Int J Clin Chem. 2022 Dec 1;537:87–95. 41. Bode AP, Lust RM. Masking of heparin activity in the activated coagulation time (ACT) by platelet procoagulant activity. Thromb Res. 1994 Mar 1;73(5):285–300. 42. Zhang X, Jiang R, Lin H, Xu S. antibody cell cultures. Biotechnol Prog. 2020 Jul;36(4):e2975. 43. Göbel F. Direct measurement of pure absorbance spectra of living phototrophic microorganisms. Biochim Biophys Acta. 1978 Feb 1;538(3):593–602. 44. Lu J, Genzen JR, Grenache DG. Development of an enzymatic assay to measure lactate. Clin Chim Acta Int J Clin Chem. 2018 Aug;483:142–4. 45. Bonaventura JM, Sharpe K, Knight E, Fuller KL, Tanner RK, Gore CJ. Reliability and accuracy of six hand-held blood lactate analysers. J Sports Sci Med. 2015 Mar;14(1):203–14. 46. Pyne DB, Boston T, Martin DT, Logan A. Evaluation of the Lactate Pro blood lactate analyser. Eur J Appl Physiol. 2000 May;82(1–2):112–6. 47. Ganapathy-Kanniappan S, Geschwind JFH. Tumor glycolysis as a target for cancer therapy: progress and prospects. Mol Cancer. 2013 Dec 3;12:152. 48. Chaudhry R, Varacallo M. Biochemistry, Glycolysis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 29]. p. 25–32. Available from: 49. Roach PJ, Depaoli-Roach AA, Hurley TD, Tagliabracci VS. Glycogen and its metabolism. Biochem J. 2012 Feb 1;441(3):763–87. 50. Mizock BA. Lactic acidosis. Dis--Mon DM. 1989 Apr;35(4):233–300.
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