外科应激患者肉毒碱代谢变化的多中心临床研究(附120例患者测定结果)

Multi-center Clinical Survey on the Changes of L-carnitine Metabolism in Surgically Stressed Patients(with the assayed results of 120 cases)

目的调查外科患者应激时肉毒碱代谢的变化情况,为术后应用肉毒碱提供依据。方法采用多中心临床调查研究,以高效液相色谱法测定血浆和尿液总肉毒碱及游离肉毒碱含量。结果3个中心患者血浆和尿液肉毒碱变化趋势一致。外科应激患者日尿总肉毒碱(totalcarnitine,TC)和游离肉毒碱(freecarnitine,FC)排出量及血浆TC和FC水平男性患者组高于女性患者组,两组间差异有显著性(P<0.05);应激患者日尿TC和FC排出量均高于同性别健康人(P<0.01),血浆TC和FC水平均低于同性别健康人(P<0.05);男性和女性患者日尿TC和FC排出量均与APACHE-2评分呈正相关(r>0.761,P<0.05),血浆TC和FC水平均与APACHE-2评分呈负相关(r<-0.726),(P<0.05)。结论外科应激患者日尿肉毒碱排出量及血浆肉毒碱水平在男性组显著高于女性,与相同性别健康人相比,患者日尿肉毒碱排出增多、血浆肉毒碱水平降低,日尿肉毒碱排出量及血浆肉毒碱水平与APACHE-2评分有关。

Objective To make a survey on the changes of daily urinary excretion of tota l L-carnitine(TC)and free L-carnitine (FC)and the changes of the plasma lev el of TC and FC in surgically stressed patients so as to obtain the evidence for postoperative supplement of L-carnitine.Methods A multi-center survey was co nducted with the basal inclusion criteria of APACHE-2≥7.The same inclusion criteria,energy supply and the same procedure for specimen collection were tak en in the three medical centers.TC and FC were assayed with high performance li quid chromatography(HPLC).The CV of the methods were in the range of0.3%-9.1%and the recovery in94.4～102.2%.Results The same trend of ca rnitine changes in plasma and urine of surgically stressed patients were found in the three separate centers (40cases for each center).The data(120cas es)showed that(1)The daily urinary TC and FC excretion and the level of TC a nd FC in plasma of male patients were significantly higher than those of female patients(P<0.05).(2)For male patients The daily urinary TC and FC excretion(827.2±90.8,524.0±6 5.8)mmol/L,which were of significant positive correlation with APACHE-2sc ore(r>0.787,P<0.05),were significantly higher than that of health y male(386.1±22.9)mmol/L,(180.5±31.8)mmol/L(P<0.0 1).The level of TC and FC in plasma (41.3±5.7)mmol/L,(29.7± 3.8)mmol/L,which were of significant negative correlation with APACHE-2sc ore(r<-0.755,P<0.05),were significantly lower than that of healt hy male(53.1±8.5)mmol/L,(41.2±6.1)mmol/L(P<0.05).( 3)For female patients:The daily urinary TC and FC excretion(508.8±62 .3)mmol/L,(324.9±36.4)mmol/L,which were of significant positiv e correlation with APACHE-2score(r>0.761,P<0.05),were significan tly higher than that of healthy female(240.1±35.6)mmol/L,(112. 7±22.6)mmol/L(P<0.01).The level of TC and FC in plasma (32.8 ±3.4)mmol/L,(23.4±2.7)mmol/L,which were of significant negativ e correlation with APACHE-2score(r<-0.726),(P<0.05),were sign ificantly lower than that of healthy female(45.4±5.6)mmol/L,(35. 2±4.9)mmol/L (P<0.05).Conclusions The daily urinary carnitine exc retion was higher and the level of carnitine in plasma was lower in surgically stressed patients than that of the same gender healthy volunteers.Both the dai ly urinary carnitine excretion and the level of carnitine in plasma of surgical ly stressed patients were correlated with APACHE-2score.