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Intérêts potentiels de la citrulline en réanimation

Potential interests of citrulline in critically ill patients

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Réanimation

Résumé

De par son métabolisme très particulier, la citrulline (CIT) est un biomarqueur reconnu de la masse intestinale fonctionnelle. Chez le malade agressé et infecté en réanimation, la CIT plasmatique est souvent effondrée, de l’ordre de 10 μmol/L (valeurs normales: 38±8 μmol/L). Cette perturbation est multifactorielle car, chez ces patients, il peut exister une augmentation du recyclage de la CIT en arginine et/ou une déplétion en ce second acide aminé. Enfin, l’existence d’une défaillance multi-organique complique encore les choses. Des études expérimentales, réalisées dans des modèles murins de sepsis, fournissent des résultats prometteurs, en particulier sur la microcirculation intestinale. Il reste à confirmer ces résultats en clinique.

Abstract

Due to its highly specific metabolism, citrulline (CIT) is now recognized as a biomarker of functional intestinal mass. In the stressed and septic critically ill patient, plasma CIT is often very low at ∼10 μmol/L (normal range: 38±8 μmol/L). These abnormal values are difficult to interpret as patients may present increased CIT recycling into arginine and/or arginine depletion. Additionally, multiple organ failure may further make this issue complex. Experimental studies in rodent models of sepsis have raised promising results, particularly regarding gut microcirculation, which now need to be confirmed by ongoing randomized clinical trials.

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Authors and Affiliations

  1. Service de biochimie interhospitalier Cochin — Hôtel-Dieu, AP-HP, et service de nutrition, EA 4466, département de biologie expérimentale, métabolique et clinique, Faculté de pharmacie, Université Paris Descartes, Paris, Russia

    L. Cynober

  2. Service interhospitalier de biochimie, GH Cochin-Broca, Hôtel-Dieu (HUPC), 27 rue du Faubourg Saint Jacques, F-75014, Paris, France

    L. Cynober

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Cynober, L. Intérêts potentiels de la citrulline en réanimation. Réanimation 22, 350–357 (2013). https://doi.org/10.1007/s13546-013-0691-x

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  • DOI: https://doi.org/10.1007/s13546-013-0691-x

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