Debats Iris B J G, Booi Darren, Deutz Nicolaas E P, Buurman Wim A, Boeckx Willy D, van der Hulst Rene R W J
Department of Plastic and Reconstructive Surgery, Maastricht Academic Hospital, Maastricht, The Netherlands.
J Surg Res. 2006 Aug;134(2):205-14. doi: 10.1016/j.jss.2006.03.005. Epub 2006 Apr 21.
Several experimental studies have shown the importance of arginine in wound healing. However, little is known about its role in human wound healing. In this study, we investigated arginine metabolism in impaired wound healing.
Twenty patients with chronic wounds and 10 patients with acute wounds were included in a prospective study. Amino acids, nitrate/nitrite, and arginase concentrations were determined in plasma and wound fluid using high-performance liquid chromatography and enzyme-linked immunosorbent assay. Chronic wounds were divided into two groups: noninfected chronic wounds (n = 11) and infected chronic wounds (n = 9), based on quantitative bacterial analysis of wound fluid samples.
Plasma arginine levels, next to total plasma amino acid levels, were significantly decreased in patients with infected chronic wounds compared with patients having acute or noninfected wounds. Citrulline and ornithine levels were significantly increased in infected chronic wounds and related to decreased nitrate/nitrite levels, whereas wound fluid arginine levels were similar in all groups. In addition, wound fluid arginase levels of infected chronic wounds were significantly enhanced.
This study demonstrates that patients with infected chronic wounds have decreased plasma arginine levels and suggests enhanced arginine conversion in the wound. In contrast to noninfected chronic wounds, arginine seems to be mainly metabolized by arginase in infected chronic wounds. In conclusion, our hypothesis is that impaired wound healing is related to an altered arginine usage.
多项实验研究已表明精氨酸在伤口愈合中的重要性。然而，其在人类伤口愈合中的作用却鲜为人知。在本研究中，我们调查了伤口愈合受损时的精氨酸代谢情况。
一项前瞻性研究纳入了20例慢性伤口患者和10例急性伤口患者。使用高效液相色谱法和酶联免疫吸附测定法测定血浆和伤口渗出液中的氨基酸、硝酸盐/亚硝酸盐及精氨酸酶浓度。根据伤口渗出液样本的定量细菌分析，将慢性伤口分为两组：非感染性慢性伤口（n = 11）和感染性慢性伤口（n = 9）。
与急性伤口或非感染性伤口患者相比，感染性慢性伤口患者的血浆精氨酸水平以及血浆总氨基酸水平显著降低。感染性慢性伤口中的瓜氨酸和鸟氨酸水平显著升高，且与硝酸盐/亚硝酸盐水平降低相关，而所有组的伤口渗出液精氨酸水平相似。此外，感染性慢性伤口的伤口渗出液精氨酸酶水平显著升高。
本研究表明，感染性慢性伤口患者的血浆精氨酸水平降低，提示伤口中精氨酸转化增强。与非感染性慢性伤口不同，在感染性慢性伤口中，精氨酸似乎主要通过精氨酸酶进行代谢。总之，我们的假设是伤口愈合受损与精氨酸利用改变有关。
