严重烧伤患者休克期降钙素基因相关肽及神经肽Y的变化对心脏功能的影响

The influence of changes in the levels of calcitonin gene-related peptide and neuropeptide Y on cardiac function of severe burn patients during shock stage

目的研究严重烧伤患者休克期降钙素基因相关肽(CGRP)、神经肽Y(NPY)的变化对心脏功能的影响。方法将60例严重烧伤(烧伤总面积32％-96％TBSA)患者设为试验组,常规进行休克期液体复苏和创面处理;另选60例健康志愿者作为对照组。检测试验组患者伤后1、3、6、12、24、48 h和对照组人员血液中CGRP、NPY、心肌肌钙蛋白T(cTnT)的含量,并对其进行相关性分析。结果伤后3 h试验组患者CGRP水平为(28±6)ng／L,较对照组(55±7)ng／L降低,12 h达低谷(15±4)ng／L,伤后48 h仍低于对照组(P<0．05)。伤后1h试验组NPY、cTnT值[(136±20) ng／L、(0．41±0．08)μg/L]较对照组[(86±13)g／L、(0.16±0．06)／μg／L]升高,12 h达峰值[(189±31)ng／L、(1．78±0．47)μg／L],48 h仍高于对照组(P<0．05)。CGRP与cTnT变化呈显著负相关(r=-0.76,P<0．01);NPY与cTnT变化呈显著正相关(r=0．79,P<0．01)。结论血液中CGRP值降低、NPY值升高在严重烧伤休克期心肌损害中可能起着重要作用。

Objective To investigate the influence of the changes in the levels of calcitonin gene-related peptide （CGRP） and neuropeptide Y （NPY） on cardiac function of severe burn patients during shock stage. Methods Sixty severe burn patients with total burn surface area larger than 30% were enrolled as experiment group （ E group） , and they received fluid resuscitation and debridement during shock stage. Sixty healthy volunteers were enrolled as control group （C group）. The changes in the plasma level of CGRP, NPY and cTnT in E and C groups were observed at 1,3,6,12,24,48 post-burn hours （PBH）. The correlation among the CGRP, NPY and cTnT in the C group were analyzed. Results At 3 PBH, the plasma level of CGRP in E group （28 ±6）ng/L was lower than that in C group （55 ±7）ng/L , and it reached the lowest level at 12 PBH （15 ±4）ng/L. It was still lower than that in C group at48PBH （ P 〈0.05）. The levels of NPY and cTnT in E group were significantly increased at 1PBH [ （ 136 ± 20 ） ng/L, （0.41 ± 0.08 ） μg/L ] compared with that in C group[ （ 86 ± 13 ） ng/L, （ 0.16 ± 0.06 ） μg/L ], peaking at 12PBH [ （ 189 ± 31 ） ng/L, （ 1.78 ± 0.47） μg/L] ,and remaining higher than those in C group at 48PBH. There exhibited obvious negative correlation between the changes in the level of CGRP and cTnT （ r = - 0.76, P 〈 0.01 ）, while obvious positive correlation was found between the changes in level of NPY and cTnT （ r = 0.79, P 〈 0.01 ）. ConelusionThe decrease in CGRP level and the increase in NPY level might play important roles in myocardial injury during shock stage of severe burn patients.