兔重度创伤后急性微量元素变化与多器官功能障碍综合征及死亡的关系

Study of correlation between the acute changes of trace element and occurrence of multiple organ dysfunction syndrom and death after severe trauma

目的:探讨严重创伤后微量元素(TE)变化与继发多器官功能障碍综合征(MODS)及死亡的关系。方法:建立创伤严重度评分(ISS)为22分的严重创伤家兔模型,观察伤后12h、36h、60h、6d、9d、14d、21d、28d家兔的内脏形态学改变,同步检测血Zn、Se、Cu、Fe含量及其相关酶和产物GPX、SOD、MPO、MDA含量变化,以及血AST、ALT、Cr、BUN等生化指标含量变化。结果:重伤后血Zn、Fe、Se含量明显下降,持续2～3周。GPX活性明显下降,持续1周;SOD活性伤后1d下降,之后快速升高;MPO活性1周内升高,之后逐渐降至正常水平;MDA含量第3天开始升高,第6天达高峰。严重创伤组家兔伤后3～6d死亡率为26%,血生化指标符合MODS,病理学检查符合MOF改变。结论:严重创伤可引发血Se、Fe、Zn等急性TE缺乏及其相关酶活性和代谢产物变化,提示TE可能参与MODS的发生过程。

Objective To study the changes of trace element （TE） and its relation with occurrence of multiple organ dysfunction syndrom （MODS） and death after severe trauma. Methods A model of severe traumatic rabbits with ISS= 22 was established to observe the morphologic change of organs and to measure the changes in serum Zn, Se, Cu, Fe levels, and the activity or concentration of their relative markers glutathione peroxidase （GPX）, superoxide dismutase（SOD）, myeloperoxidase （MPO）, malonaldehyde （MDA）, and the content of biochemical markers AST, ALT, Cr ＆ BUN at 12 h, 36 h, 60 h, 6 d, 9 d, 14 d, 21 d and 28 d after the trauma. Results The result showed that serum Se, Zn, Fe content decreased very significantly and were sustained 2-3 weeks after trauma. The GPX activity dropped markedly during first week, and the SOD activity decreased in the first day and then recovered quickly. The MPO activity increased gradually during the first week after trauma, and then returned to the normal level gradually. The MDA content increased gradually on the 3rd days and reached the peak level on the 6^th day after trauma. Seven rabbits died on days 3 to 6 after trauma with a mortality of 35%, and their biochemical markers reached 2-3 time of the normal level in compliance with MODS, and the pathological features were in compliance with those of MOF. Conclusions Severe trauma could lead to acute Se, Zn, Fe deficiency, and related changes in enzyme activities, indicating that TE take part in the mechanism of occurrence of MODS and death after severe trauma.