严重烧伤脓毒症患者骨骼肌蛋白降解变化机制研究

目的研究严重烧伤脓毒症患者骨骼肌蛋白降解变化及机制。方法 2012年1～6月收集严重烧伤伴脓毒症患者8例为脓毒症组。同时选择整形患者10例作为对照。检测对照组及脓毒症组伤后3、5、7、14、21d血清中肿瘤坏死因子-α、皮质醇、尿液中3-甲基组氨酸的含量,以及股四头肌中泛素基因表达和蛋白表达。结果脓毒症组烧伤后3、5、7、14、21d各指标均显著高于对照组,差异有统计学意义(P<0.01)。脓毒症组皮质醇、TNF-α、3-MH在烧伤后逐渐升高,7d时达到高峰,后逐渐下降,但在21d时仍然高于对照组。尿内3-MH的排泄量与血TNF-α和皮质素水平的变化呈正相关,r=0.89、0.91,P<0.01。脓毒症组股四头肌组织内泛素mRNA、E2-14k mRNA、C2亚基的mRNA、蛋白酶体C2亚基蛋白的表达较对照组均显著增加。结论严重烧伤脓毒症患者出现骨骼肌降解,与皮质醇、TNF-α升高有一定的关系。     

严重烧伤脓毒症患者骨骼肌蛋白分解代谢的临床研究

目的分析严重烧伤脓毒症患者骨骼肌蛋白降解变化及其生物学机制。方法收集同期收治的20例严重烧伤脓毒症患者(烧伤脓毒症组)和12例整形患者(对照组)的血、24h尿和股四头肌标本,通过放免法测定血浆皮质醇和肿瘤坏死因子(TNF)-α含量,高效液相-色谱分析法检测股四头肌内3-甲基组氨酸(3-MH)含量以及尿中3-MH排出量,核糖核酸印迹法检测股四头肌内编码泛素、E2-14k和蛋白酶体C2亚基的mRNA表达变化。蛋白免疫印迹法检测股四头肌内蛋白酶体C2亚基的蛋白表达变化。结果烧伤脓毒症组血浆内皮质醇含量(478±56)μg/L和TNF-α含量(22·4±3·8)μg/L均显著高于对照组血内皮质醇含量(72±12)μg/L和TNF-α含量(0·5±0·1)μg/L(均P<0·01)。烧伤脓毒症组股四头肌内3-MH含量(4·3±0·6)μmol/g及24h尿内3-MH排出量(456±25)μmol均显著高于对照组股四头肌内3-MH含量(2·5±0·4)μmol/g和24h尿内3-MH排出量(202±29)μmol(均P<0·01)。烧伤脓毒症组股四头肌泛素mRNA2·4kb条带和1·2kb条带的表达分别较对照组增强51%和32%,差异有统计学意义(P<0·01);E2-14k mRNA1·2kb条带的表达较对照组增强75%,差异有统计学意义(P<0·01);蛋白酶体C2亚基mRNA和蛋白表达分别较对照组增强39%和130%,差异有统计学意义(P<0·01)。结论重症烧伤脓毒症时骨胳肌蛋白降解显著增强,体内糖皮质激素及TNF-α含量增加,从基因水平激活细胞内蛋白降解途径-泛素系统是重症烧伤脓毒症患者骨胳肌蛋白降解增强的原因之一。     

烫伤后早期肠道喂养对骨骼肌蛋白质分解代谢影响的研究

目的 探讨烫伤后早期肠道喂养（ＥＥＦ）能否抑制骨骼肌蛋白质分解代谢。方法 给予３７％ＴＢ－ＳＡⅢ度烫伤大鼠早期（伤后２ｈ）或延迟（伤后２４ｈ）肠道喂养安素营养液，观察伤后第５天经目鱼肌总Ｔｙｒ释放率及２０Ｓ蛋白酶复合体的活性，以及血中ＴＮＦ、皮质酶水平。结果 烫伤后ＥＥＦ大鼠比目鱼肌总Ｔｙｒ释放率及２０Ｓ蛋白酶复合体活性，血中ＴＮＦ、皮质醇水平的升高程度均显著低于延迟肠道喂养组大鼠。结论 烧伤后Ｅ     

严重烧伤后高迁移率族蛋白B1的变化及其与脓毒症的关系

目的动态观察严重烧伤患者血浆中高迁移率族蛋白B1(HMGB1)水平的变化并探讨其与脓毒症及内毒素血症的关系。方法25例烧伤总体表面积大于30%患者,根据是否并发脓毒症分组(脓毒症组14例、非脓毒症组11例),采用酶联免疫吸附实验及改良基质显色法鲎实验分别检测患者伤后1、3、5、7、14、21、28d血浆HMGB1及内毒素含量的变化。结果严重烧伤患者伤后第1天血浆中HMGB1含量显著升高,其中伤后第7、21、28天脓毒症组HMGB1含量显著高于非脓毒症组(P<0.05)。脓毒症患者存活组伤后第3、21天HMGB1含量显著低于非存活组(P<0.05,P<0.01),血浆中HMGB1含量与是否易并发脓毒症有关,但与烧伤总体表面积无相关性(P>0.05)。伤后第3、5、7、21天血浆HMGB1与内毒素含量呈显著正相关(P<0.05,P<0.01)。结论HMGB1作为重要的晚期炎症介质参与严重烧伤后脓毒症的病理生理过程,其诱生与内毒素刺激密切相关,动态观察其水平有助于烧伤后病程监测及患者预后判断。     

严重体表烫伤早期TNF对骨骼肌蛋白质分解代谢影响的实验研究

为探讨烧伤后骨骼肌蛋白质解分解代谢的变化规律及其可能机理，以３７％体积表面各Ⅲ度烫伤大鼠为模型，于伤后１周内动态观察了创伤局部与远隔部位骨骼肌蛋白质分解代谢速率与ＴＮＦ含量的动态变化。     

血液滤过治疗严重烧伤脓毒症合并高钠血症的临床护理

1　临床资料　8例重症烧伤脓毒症合并高钠血症患者,男性6例,女性2例,平均年龄2 4～72 (4 6±9)岁,烧伤总面积为84 .3%±12 .5 % ,治疗前平均血钠浓度(170±7)mmol/L(16 0～179mmol/L)。均使用持续性静脉 静脉血液滤过(CVVH)治疗。采用Seldinger方法于锁骨下或颈内静脉留置单针双腔导管,建立体外循环,采用PRISMA型血滤机进行CVVH治疗。血滤器为AN6 9型(磺化聚丙烯腈膜,面积1.0m2 ) ,管路和滤器均按常规方法使用。置换液采用以Port配方为基础,钠离子浓度调整为15 0～135mmol/L ,适当补充钾离子。床边连续滤过5～8h。治疗过程中血流量…     

严重烧伤患者早期血清C反应蛋白的变化

目的探索严重烧伤患者早期血清急性期蛋白质的变化。方法对30例总面积大于50%患者,于伤后12、24、487、2小时采血,且对18例切削痂患者于术后24小时采血,以免疫速率散射浊度法测定CRP(C反应蛋白)。结果伤后12~72小时血清CRP值逐步升高;切削痂术后24小时血清CRP值更高(P<0.01)。结论CRP的变化主要反映组织损伤的程度,并非预示脓毒性的易感性。     

C-反应蛋白下降率对判断严重脓毒症患者预后的作用

目的：探讨治疗后 C-反应蛋白（CRP）下降率对评估严重脓毒症患者预后的作用。方法选择确诊为严重脓毒症的103例患者,根据治疗3 d 后 CRP 下降率分为 A 组（治疗3 d 后 CRP 较治疗前下降＜30％）、B 组（治疗3 d 后 CRP 较治疗前下降30％～50％）、C 组（治疗3 d 后 CRP 较治疗前下降≥50％）,比较3组患者机械通气带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率。结果A 组患者与 B、C 组患者机械通气平均带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率比较差异均有统计学意义（P ＜0．05）。B 组患者机械通气平均带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率均高于 C 组,但差异无统计学意义（P ＞0．05）。判断脓毒症患者存活的治疗后3 d CRP 下降率的最佳界点值为31．48％,敏感性为86．54％,特异度为100％。结论严重脓毒症抗感染治疗3 d 后 CRP 下降率是一个敏感性好、特异性强的用于判断患者预后良好的指标。     

老年严重感染时的高分解代谢与营养支持

老年人多患有一种或多种重要脏器的慢性疾病,一旦发生较为严重的感染,几乎均出现高分解状态,且代谢异常。对外源性营养底物利用率低,主要靠分解自身组织获取能量,其中对蛋白的消耗增幅最大,可在短期内导致蛋白-能量营养不良。在前10天,2／3的氨基酸利用米白骨骼肌,以后更多地转向内脏。即使提供充足的营养,也不能完全阻止瘦体组织（无脂组织群）的分解。     

慢性阻塞性肺病大鼠骨骼肌蛋白降解的变化

目的 探讨慢性阻塞性肺病(COPD)大鼠骨骼肌蛋白降解代谢变化的规律.方法 利用熏香烟法制作COPD大鼠模型(COPD组),并设置对照组,每组20只.取伸趾长肌充氧离体孵育,采用高效液相-荧光法测量骨骼肌3-甲基组氨酸(3-MH)和酪氨酸(Tyr)的含量.结果 孵育后,COPD组大鼠Tyr及3-MH的降解率与对照组比较,差异均有统计学意义(P＜0.01,P＜0.001).结论 COPD大鼠不仅全身骨骼肌总蛋白降解增加,作为机体蛋白质储存库重要组成部分的骨骼肌肌蛋白消耗更为明显.     

慢性阻塞性肺病大鼠骨骼肌蛋白降解的变化

目的探讨慢性阻塞性肺病(COPD)大鼠骨骼肌蛋白降解代谢变化的规律。方法利用熏香烟法制作COPD大鼠模型(COPD组),并设置对照组,每组20只。取伸趾长肌充氧离体孵育,采用高效液相-荧光法测量骨骼肌3-甲基组氨酸(3-MH)和酪氨酸(Tyr)的含量。结果孵育后,COPD组大鼠Tyr及3-MH的降解率与对照组比较,差异均有统计学意义(P<0.01,P<0.001)。结论COPD大鼠不仅全身骨骼肌总蛋白降解增加,作为机体蛋白质储存库重要组成部分的骨骼肌肌蛋白消耗更为明显。     

Successful treatment of invasive burn wound infection with sepsis in patients with major burns

Objective To investigate the clinical characteristics of invasive burn wound infection wit h sepsis in patients with major burns and to summarize the successful experience s in the treatment of such patients. Methods Eight patients with major burns, complicated by invasive burn wound infection an d sepsis were consecutively admitted to our hospital from September 1997 to Octo ber 1998.Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock.The plasma concentrations of IL-6, IL-8, TNFα and lypopolysaccharide (LPS) were assayed before and after surgical inter vention, as well as when the patient’s vital signs became stable.Results The patients’ conditions usually deteriorated abruptly when extensive invasive b urn wound infection emerged.While multi-microbial infection was usually found , Pseudomonas aeruginosa was the predominant bacteria isolated from the sube schar tissue.The plasma concentrations of IL-6, IL-8, TNFα and LPS before s urgical intervention were significantly higher than those after surgical interve ntion (P&lt;0.05).The lowest levels of the inflammatory mediators were obser ved when the patients’ conditions became stable, and the values were signifi cantly lower than those before surgical intervention (P&lt;0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a large area of i nfected burn wound, they should be excised and covered as early as possible.LP S and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis.Although favorable results should be attributed to comprehensive t reatment, we believe that early, aggressive and thorough surgical excision of in fected burn wounds, followed by sound and complete coverage of the area, play a crucial role.     

Influence of insulin treatment on hyperproteolysis of skeletal muscle in scald sepsis in rabbits

Objective To study the regulative effects of intensive insulin treatment on hyperproteolysis of skeletal musle in burn sepsis in rabbits. Methods Male white rabbits were injured with boiling water and endotoxin （2 mg/kg） to establish scald and sepsis model. The plasma glucose level in physiologicrange was controlled with insulin and the proteolytic rate and the expression of proteasome in extensor digitorium longus were determined.     

应重视戈谢病的骨骼病变

戈谢病又称高雪病,属于溶酶体贮积症的一种,是一种少见的家族性糖脂代谢障碍性疾病.该病为常染色体隐性遗传病,是由于基因突变导致体内β-葡萄糖脑苷脂酶的遗传性缺陷造成的.在正常情况下,人体内葡萄糖脑苷脂在这种酸性溶酶体酶的作用下,水解为葡萄糖及N-酰基鞘氨醇.当此酶缺乏时引起底物代谢障碍,大量沉积于各脏器的单核巨噬细胞系统内而致病.     

Experimental study on mechanism and rarity of metastases in skeletal muscle

Objective To investigate the reasons for the rarity of metastases in skeletal muscle.Methods By injecting tumor cells (Walker256 rat carcinosarcoma) through the iliac artery(experimental group) and the tail vein (control group), animal models of blood- borne metastases were established. The quadriceps femoris muscle and lungs were observed grossly and microscopically. Immunohistochemistry was applied to investigate the expression of vascular cell adhesion molecule- 1 (VCAM- 1) in the microvascular endothelium of these organs. Primary culture of rat skeletal muscle cells was established and conditioned medium (MCM) was collected. Effects of MCM on several tumor cell lines and the biochemical characteristics of skeletal muscle delivered tumor factor(s) were tested by MTT assay. Apoptosis and morphological examination were carried out to investigate the antitumor mechanisms of MCM. Results In the experimental group, there were no definite metastases observed in muscle cells. In the control group, lung metastases were present in the lungs of all rats that were sacrificed at the 14th day or died spontaneously (17 rats in all). There was no significant difference between the increase in VCAM- 1 in quadriceps femoris muscle 7 days after iliac artery injection and that in lungs 7 days after tail vein injection (P&gt;0. 05). In vitro studies showed that the proliferation of tumor cell lines of mouse SP2/0 myeloma, rat Walker256 carcinosarcoma or human chronic granulocytic leukemia K562, human acute lymphatic leukemia HL- 60, LS- 174- T colon adenocarcinoma, PC3- M prostatic carcinoma and lung giant cell carcinoma with different metastatic potency (PLA801- C with low metastatic potency, PLA801- D with high metastatic potency) was significantly inhibited when cultured with MCM (P&lt;0. 01-0. 05). Proliferation of malignant cells showed a dose- dependent decrease, to a certain degree. Proliferation of normal rabbit joint epiphysial disk cells (RGP- 2) were not affected by MCM. Proliferation of lung giant cell carcinoma cells with high metastatic potency showed a significant decrease even when cultured in highly diluted MCM (6. 25% of primary MCM), when compared with the strain of low metastatic potency. Following ultrafiltration, boiling at 100℃, and treatment with trypsin, skeletal muscle delivered tumor factor(s) were found to be a low molecular weight (MW≤10. 0 KDa) component which was trypsin resistant but not heat resistant. The factor(s) did not induce apoptosis in K562 cells but caused direct destruction of the cytoplasmic membrane. Conclusions The rarity of metastases in skeletal muscles, generally accepted in the clinical setting, can be reproduced in an animal model. It does not seem to be related to VCAM- 1 expression in the microvessels of these organs. Skeletal muscle delivered factor(s) play a key role in the mechanism of the rarity of metastases in skeletal muscle.     

Dynamic study of TNF effects on skeletal muscle proteolysis in early stage of severe scalding in rats

ＤｙｎａｍｉｃｓｔｕｄｙｏｆＴＮＦｅｆｆｅｃｔｓｏｎｓｋｅｌｅｔａｌｍｕｓｃｌｅｐｒｏｔｅｏｌｙｓｉｓｉｎｅａｒｌｙｓｔａｇｅｏｆｓｅｖｅｒｅｓｃａｌｄｉｎｇｉｎｒａｔｓ￥ＬｉＬｉｎ（李林）；ＤｏｎｇＹａｎｌｉｎ（董燕麟）；ＹａｎｇＣｈｕｎ（杨春）；...