Die metabolische Selbstzerstörung des kritisch kranken Patienten (Teil I): Evolutionsbiologische Hintergründe, Mechanismen und Sinnhaftigkeit^{[1] [2]}

Zusammenfassung

Die Übersicht möchte potenziell selbstzerstörerische metabolische Reaktionen, die man häufig bei kritisch kranken Patienten beobachten kann, aus evolutionsbiologischer Sicht betrachten, und dabei in einem 1. Teil auf deren Ursprung, Mechanismen und Sinnhaftigkeit genauer eingehen. Metabolische Reaktionen, die besonders nach chirurgischer Homöostasestörung (Trauma, Sepsis) regelhaft auftreten, umfassen die Hyperglykämie, die Insulinresistenz, eine erhöhte hepatische Glukoseproduktion und einen gesteigerten muskulären Eiweißabbau. Aus evolutionsbiologischer Sicht waren diese metabolischen Sekundärreaktionen notwendig und auch erfolgreich. Nur dadurch konnte im Rahmen der Phylogenese die Wahrscheinlichkeit erhöht werden, leichtere chirurgische Traumata auch ohne fremde Hilfe (spontan) überleben zu können. Teleologisch stand dabei die Gewährleistung zellulärer Funktionen, die für Infektabwehr und Gewebereparatur unerlässlich sind, im Vordergrund. Aufgrund unvermeidbarer evolutionsbiologischer Zwänge haben diese metabolischen Sekundärreaktionen bis in die Neuzeit hinein überlebt.

Abstract

The present study wants to analyse potentially self-destructive metabolic responses observed in critically ill patients from an evolutionary perspective specifically focusing on origins, nature, and principal usefulness. Metabolic reactions associated with surgical injury or infection comprise hyperglycemia, insulin resistance, increased hepatic glucose production and muscle protein breakdown. From an evolutionary perspective these responses have been necessary and successful to overcome spontaneously survivable insults (minor surgical trauma) by maintaining function of immune-competent and reparative cells. There is, however, overwhelming evidence that extreme metabolic responses have not been selected by evolution, but may have persisted because of unavoidable evolutionary constraints.

Schlüsselwörter

Autokannibalismus - schwere Sepsis - Trauma - Schock - Phylogenese - Evolution - Hyperglykämie - Kohlenhydratstoffwechsel - Proteinstoffwechsel - adaptive Reaktion

Keywords

auto-cannibalism - severe sepsis - trauma - shock - phylogenesis - evolution - hyperglycemia - carbohydrate metabolism - protein metabolism - adaptive response

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