Stupnytskyi M.A., Zhukov V.I.

Kharkiv national medical university, biochemistry department

Peculiarities of the oxidative disorders diagnostic in case of the severe combined thoracic trauma based on the correlation analysis.

Oxidative stress is the essential part of polytrauma pathogenesis [6]. Tissue injury results into local and systemic release of proinflammatory cytokines and phospholipids proportionally to severity of polytrauma. Activated neutrophils are able to induce secondary tissue and organ damage by formation of reactive oxygen species [7]. Of more importance for oxidative tissue damage and organ dysfunction is the reperfusion phase after shock management. Oxidative cell injury involves the modification of cellular macromolecules by reactive oxygen species, often leading to cell death [4]. However, diagnostic value of the oxidative stress markers for metabolic monitoring is not investigated at all yet.

The aim of this study was to determine the diagnostic value of the lipids’ and proteins’ oxidative damage markers for metabolic monitoring of the severe combined thoracic trauma based on correlative analysis.

Study was performed on 73 male patients aged from 20 to 68 who were treated at the anesthesiology and intensive care department for patients with combined trauma of Kharkiv city clinical hospital of emergency aid named by prof. O.I. Meshchaninov. Patients with severe blunt combined thoracic trauma with pneumothoraxes and hemothoraxes, lung contusions, heart contusions and multiply (>3) rib fractures were included in this study. Patients’ examinations were performed on 1-2-d day after trauma (10.75-33.5 hours after trauma), 3-4-th day (48-75.2 hours) and 5-6-th day (97-122 hours). Plasmatic concentration of malondialdehyde was determined according to TBA-activity of deproteined plasma [5]. The protein’s carbonyl groups level was determined with the help of dinitrophenylhydrazine reaction with plasma proteins extracted from blood [2]. Total protein concentration was determined according to biuret method [3]. Statistical analysis was performed using the GraphPad Prism 5.03. For investigation the relationship between two variables Spearman correlation coefficient was used. The significance level was specified as p <0.05.

Moderate negative relationship between malondialdehyde concentration and volume of colloid solutions that were infused before examination was observed. Moderate negative correlation coefficient with total infusion volume was found too. Moderate negative relationships between carbonyl groups level and both volumes of total infusion and colloid solutions were obtained. These data indicates great influence of hemodilution on concentrations of both oxidative damage markers. Strong negative relationships were observed between abdominal AIS score and both malondialdehyde and carbonyl groups levels, estimated on 1-2-d day after trauma. Massive blood loss always accompany severe abdominal trauma and it determines the volume of fluid resuscitation [1]. The division of malondialdehyde and carbonyl groups concentrations into the total protein concentration was decided for the adjustment of oxidative stress markers.

Weak negative relationships between hemoglobin concentration and both relative concentrations of malondialdehyde and carbonyl groups were observed. Maderate positive relationship between relative malondialdehyde concentration and blood urea concentration was obtained. Weak positive relationship between relative concentration of carbonyl groups, estimated on 1-2-d day after trauma and RTS-score, calculated on admission, was observed.

These data allows us to make next conclusions. The absolute concentrations of investigated markers do not represent the activity of oxidative processes in case of massive infusion therapy. The malondialdehyde/total protein and carbonyl groups/total protein ratios are more representative. Oxidative stress is one of the pathophysiological elements of the endogenous intoxication syndrome owing to polytrauma. It develops during first week of polytrauma. The intensity of oxidative stress is probably proportional to the patient’s status and in case of the severe blunt combined thoracic trauma to the blood oxygen transport function status. The related concentrations of oxidative stress markers can help in evaluation and objectification of patient’s status.

References:

1. Политравма: хирургия, травматология, анестезиология, интенсивная терапия / Ф.С. Глумчер, П.Д. Фомин, Е.Г. Педаченко [и др.]. – ВСИ "Медиц. – Киев, 2012. – 736 с.

2. Окислительная модификация белков сыворотки крови человека, метод ее определения / Е.Е. Дубинина, С.О. Бурмистров, Д.А. Ходов [и др.] // Вопросы медицинской химии. – 1995. – Т. 41, № 1. – С. 24–26.

3. Уловицина Т.И. Методы определения индивидуальных белков / Т.И. Уловицина. – Красноярск, 1991. – 384 с.

4. Чеснокова Н.П. Общая характеристика источников образования свободных радикалов и антиоксидантных систем / Н.П. Чеснокова, Е.В. Понукалина, М.Н. Бизенкова // Успехи современного естествознания. – 2006. – № 7. – С. 37–41.

5. Лабораторные методики для изучения состояния антиоксидантной системы организма и уровня перекисного окисления липидов: Метод. рекомендации для докторов, аспирантов, магистров, исполнителей НИР / Н.Г. Щербань, Т.В. Горбач, Н.Р. Гусева [и др.]. – ХГМУ. – Харьков, 2004. – 36 с.

6. A Review of metabolic staging in severely injured patients / M. Aller, J. Arias, A. Alonso-poza [et al.] // Scand. J. Trauma. Resusc. Emerg. Med. – 2010. – Vol. 18, № 27. 

7. Role of Activated Neutrophils in Chest Trauma–Induced Septic Acute Lung Injury / M. Perl, C. Hohmann, S. Denk [et al.] // Shock. – 2012. – Vol. 38, № 1. – P. 98–106.