Vuceljić Marina, Zunić Gordana, Romić Predrag, Jevtić Miodrag
Military Medical Academy, Institute for Biochemistry, Belgrade, Serbia and Montenegro.
Vojnosanit Pregl. 2006 Jun;63(6):545-51. doi: 10.2298/vsp0606545v.
BACKGROUND/AIM: We have recently reported the development of oxidative cell damages in bombing casualties within a very early period after the initial injury. The aim of this study, was to investigate malondialdehyde (MDA), as an indicator of lipid peroxidation, and osmolal gap (OG), as a good indicator of metabolic cell damages and to assess their relationship with the initial severity of the injury in bombing casualties.
The study included the males (n = 52), injured during the bombing with the Injury Severity Score (ISS) ranging from 3 to 66. The whole group of casualties was devided into a group of less severely (ISS < 25, n = 24) and a group of severely (ISS > or = 26, n = 28) injured males. The uninjured volunteers (n = 10) were the controls. Osmolality, MDA, sodium, glucose, urea, creatinine, total bilirubin and total protein levels were measured in the venous blood, sampled daily, within a ten-day period.
In both groups of casualties, MDA and OG levels increased, total protein levels decreased, while other parameters were within the control limits. MDA alterations correlated with ISS (r = 0.414, p < 0.01), while a statistically significant correlation between OG and ISS was not obtained. Interestingly, in spite of some differences in MDA and OG trends, at the end of the examined period they were at the similar level in both groups.
The initial oxidative damages of the cellular membrane with intracellular metabolic disorders contributed to the gradual development of metabolic-osmotic damages of cells, which, consequently caused the OG increase. In the bombing casualties, oxidative cell damages were dependent on the initial injury severity, while metabolic-osmotic cell damages were not.
背景/目的：我们最近报道了爆炸伤伤员在初次受伤后极早期出现氧化细胞损伤。本研究的目的是调查作为脂质过氧化指标的丙二醛（MDA）和作为代谢性细胞损伤良好指标的渗透压间隙（OG），并评估它们与爆炸伤伤员初始损伤严重程度的关系。
本研究纳入了52名男性，他们在爆炸中受伤，损伤严重度评分（ISS）范围为3至66。所有伤员被分为轻伤组（ISS<25，n = 24）和重伤组（ISS≥26，n = 28）。10名未受伤的志愿者作为对照组。在10天内每天采集静脉血，检测渗透压、MDA、钠、葡萄糖、尿素、肌酐、总胆红素和总蛋白水平。
在两组伤员中，MDA和OG水平升高，总蛋白水平降低，而其他参数在对照范围内。MDA变化与ISS相关（r = 0.414，p<0.01），而未获得OG与ISS之间的统计学显著相关性。有趣的是，尽管MDA和OG趋势存在一些差异，但在检查期结束时，两组的水平相似。
细胞膜的初始氧化损伤伴细胞内代谢紊乱导致细胞代谢 - 渗透损伤逐渐发展，进而导致OG升高。在爆炸伤伤员中，氧化细胞损伤取决于初始损伤严重程度，而代谢 - 渗透细胞损伤则不然。
