Determinants of skeletal muscle protein turnover following severe burn trauma in children
Determinants of skeletal muscle protein turnover following severe burn trauma in children
复制标题
DOI：
10.1016/j.clnu.2018.05.027
复制
发表时间：
2019-06-01
影响因子：
6.3
通讯作者：
Sidossis, Labros S.
中科院分区：
文献类型：
--
作者：
Malagaris, Ioannis;Herndon, David N.;Sidossis, Labros S.
背景和目标：烧伤仍然是全球非致命性儿科损伤的第五大原因，肌肉恶病质是烧伤应激反应的标志。烧伤引起的肌肉萎缩与发病率有关，但烧伤后肌肉蛋白酶活性的决定因素仍不清楚。我们的目的是确定烧伤patients.Methods的患者和损伤特征对肌肉蛋白动力学的影响：这项回顾性观察性研究是使用蛋白动力学数据进行的，这些数据来自于1999年至2008年期间患有严重烧伤（烧伤总体表面积的30%以上）并接受交叉肢体稳定同位素输注的儿科患者，作为前瞻性临床试验的一部分。混合多元回归模型被用来评估患者/损伤特征和肌肉蛋白质合成率（FSR），净平衡（NB），苯丙氨酸出现率（Ra;蛋白质分解指数）和消失率（Rd;蛋白质合成指数）之间的关联在leg.Results：共268例患者进行了499项研究。损伤后时间的增加与更大的FSR（p < 0.001）和NB（p = 0.01）相关。雄性比雌性分解代谢更强（如较低NB，p = 0.04和较大Ra，p = 0.008所示），这是蛋白质分解更高而非合成更低的结果。增加烧伤面积与更高的蛋白质合成率（如更高的FSR所示，p = 0.019）和更高的蛋白质分解率（如更大的Ra所示，p = 0.001）相关。FSR与年龄呈负相关（p < 0.001）。结论：来自这一大型患者队列的数据显示，损伤严重程度、性别和伤后时间影响烧伤儿童的骨骼肌消耗。这些发现表明，在设计治疗方法以改善烧伤幸存者的急性护理和康复时，应考虑患者的个体特征。(C)2018爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Background & aims: Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients.Methods: This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials. Mixed multiple regression models were used to assess associations between patient/injury characteristics and muscle protein fractional synthesis rate (FSR), net balance (NB), and rates of phenylalanine appearance (Ra; index of protein breakdown) and disappearance (Rd; index of protein synthesis) across the leg.Results: A total of 268 patients who underwent 499 studies were analyzed. Increasing time post injury was associated with greater FSR (p < 0.001) and NB (p = 0.01). Males were more catabolic than females (as indicated by lower NB, p = 0.04 and greater Ra, p = 0.008), a consequence of higher protein breakdown rather than lower synthesis. Increasing burn size was associated with higher protein synthesis rate (as indicated by higher FSR, p = 0.019) and higher protein breakdown rates (as indicated by greater Ra, p = 0.001). FSR was negatively associated with age (p < 0.001).Conclusions: Data from this large patient cohort show that injury severity, sex, and time post injury influence skeletal muscle wasting in burned children. These findings suggest that individual patient characteristics should be considered when devising therapies to improve the acute care and rehabilitation of burn survivors. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.