严重烧伤脓毒症患者骨骼肌蛋白降解变化机制研究

Mechanism of skeletal muscle protein degradation of patients with serious burn sepsis

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。

Objective To study mechanism of skeletal muscle protein degradation of patients with serious burn sepsis. Methods Eight cases with serious burn sepsis from Jan to Jun 2012 were selected as sepsis group. Ten orthopedic pa- tients were selected as control group. TNF-α,cortisol,3-MH of control group and sepsis group 3, 5, 7,14,21 d after burned. Ubiquitin gene expression and protein expression in quadriceps femoris were detected. Results TNF-α,corti- sol, 3-MH of sepsis group 3,5,7,14,21 d after burn were higher than control group obviously （P 〈 0.01 ）. TNF-α, cor- tisol,3-MH increased after burned,and reaching highest at 7 d,then decreased,but at 21 d which were higher than control group. 3-MH excretion in urine was positive correlation with TNF-α and cortisol,r = 0.89,0.91 ,P 〈 0.01. Ubiquitin mRNA,E2-14k mRNA,C2 subunit mRNA,C2 subunit protein expression of sepsis group were higher than control group. Conclusion Skeletal muscle protein degradation in patients with serious burn sepsis is positive correla- tion with TNF-α and cortisol level increasing.