Monitoring Methods And Mechanisms Of Arginine In Patients With Trauma, Burns And Major Surgery

Part1. Determination and significance of serum arginine in patientswith burnsObjective: Using high performance capillary electrophoresis to dynamicmonitoring the content of arginine in the burn patients’ serum. Provide data tosupport clinical treatment.Methods: Admitted into the first hospital of Hebei medical university,collected the serum from10cases of burn patients and10cases of normal.Using high performance capillary electrophoresis at the detection wavelengthof254nm, with fused quartz capillary (70cm×75μm,58cm effective length)and a running buffer of20mmol/L sodium tetraborate buffer (PH9.33),containing166mmol/L SDS and13%acetonitrile at a constant voltage of15kV with a sampling time of15s to determine the sample.Results: Detecting the arginine of burn patients hospitalized, the contentof arginine reached its peak after14days in the serum. Then it rapidlydecreased. But the difference between each time point was not statisticallysignificant (P>0.05). T test was used for statistical analysis, found that patientshospitalized3days,7days and14days was significantly higher than normallevels of serum arginine, and the difference was statistically significant(P<0.05). The first day, day28compared with normal subjects, the differencewas not statistically significant (P>0.05).Conclusion: Using high performance capillary electrophoresis todynamic monitoring the content of arginine in the burn patients’ serum. Themethod was simple, accurate and reliable. During hospitalization by serumarginine continuity testing, found that regular changes showed increasedgradually and then decreased rapidly, the content of arginine reached its peak after14days in the serum. These results in clinical applications arginine andarginine effect on the prognosis of patients to provide data to support.Part2. Effect of arginine-supplemented nutrition on the prognosis intrauma, burn and surgical patients: a Meta-analysisObjective: To evaluate the effect of arginine-supplemented nutrition onthe prognosis in trauma, burn and surgical patients.Methods: Studies were identified by CHKD, pubmed and CochraneCentral Register of Controlled Trials（The Cochrane Library）search fororiginal articles. According to the inclusion criteria and Jadad, data of theincluded studies were extracted, and the methodological quality was evaluated.Then meta-analysis was performed using RevMan5.1.Results: A total of26RCTs involving1704patients and16high qualitytrials were included. Meta-analyses showed that arginine interventionssignificantly effect on hospital length of stay [WMD=-1.66；95%CI(-3.20，-0.12)；P=0.04；I2=73%], Serum transferring [WMD=17.74；95%CI(9.41，26.07)；P<0.0001；I2=0%], the plasma amino acid spectrum [WMD=18.35；95%CI(12.77，23.93)； P<0.00001； I2=0%], CD4(%)[WMD=4.13；95%CI(2.55，5.72)； P＜0.00001； I2=0%], CD3(%)[WMD=13.55；95%CI(11.10，16.00)；P＜0.00001；I2=0%] in enteral nutrition, CD3(%)[WMD=5.98；95%CI(4.05，7.91)；P＜0.00001；I2=0%] in parenteral nutrition,IgA [WMD=0.09；95%CI(0.01，0.17)；P=0.03；I2=0%] in enteral nutrition,IgA [WMD=0.27；95%CI(0.08，0.45)；P=0.005；I2=0%] in parenteral nutrition,NK(%)[WMD=4.52；95%CI(3.24，5.79)；P＜0.00001；I2=25%], PGE2[WMD=-53.76；95%CI(-75.52，-31.99)；P＜0.00001；I2=55%] and theC-reactive protein with long-term nutritional wasting disease [WMD=-1.99；95%CI(-2.38，-1.59)；P＜0.00001；I2=0%].But there were significant effect on mortality [OR=1.68；95%CI(1.02，2.78)；P=0.04；I2=0%], and Serum albumin [WMD=-0.13；95%CI(-0.19，-0.07)；P<0.0001；I2=27%] in the control group. There was significant effect on septic complications in the control group with long-term nutritionalwasting disease [OR=1.73；95%CI(1.03，2.89)；P=0.04；I2=0%].There was no effect on the level of IgM [WMD=0.11；95%CI(-0.01，0.22)； P=0.07； I2=44%], and the C-reactive protein without long-termnutritional wasting disease [WMD=-0.03；95%CI(-0.06，0.01)；P=0.11；I2=52%].Conclusion: Arginine nutrition therapy can partially improve moderate,severe inflammation and immune levels in patients and for patients with verysevere disease have an increased risk of mortality, it should not use arginine.Application of arginine enhanced nutrition therapy can increase serumtransferrin protein and amino acid levels, thereby improving the nutritionalstatus of patients.Part3. The role of arginine to improve human umbilical veinendothelial cells from oxidative stressObjective: To investigate the role of arginine to improve humanumbilical vein endothelial cells from oxidative stress.Methods: Human umbilical vein endothelial cells (HUVEC) were seededin6-well plates. HUVEC were treated by10mmol/L Gln (0.5h,1h,2h and3h)in the the experimental group and control group without reagents. After30minthey were stimulated6h with100ng/ml LPS. The medium was collected afterthe pellet was discarded. According to kit instructions superoxide dismutase(SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH-PX) weremeasured. Using ANOVA to analyze the data.Results: As the concentration of arginine increased, the expression ofSOD in HUVEC cells gradually increased, and when the concentration ofarginine is1.0mmol/L, the expression of SOD reached its peak. Then itrapidly decreased. When the concentration of arginine were0.6,1.0,1.4mmol/L, SOD expression were higher than LPS group, but the differencebetween the groups was not statistically significant (P>0.05). As the concentration of arginine increased, the expression of GSH-PX in HUVECcells gradually increased. GSH-PX expression of each group were higher thanLPS group, but the difference between the groups was not statisticallysignificant (P>0.05). Experimental group with arginine concentrationincreased, MDA decreased at first and then increasing trend. When theconcentration of arginine is1.0mmol/L, the expression of MDA was thelowest. However, the experimental group MDA levels were higher thannormal and LPS group, by ANOVA to analyze the differences betweencomparison groups, found no statistically significant difference (P>0.05).Conclusion: Within a certain range of concentrations of arginine mayhave enhanced the ability of cells to oxidative stress, but also have anincreased risk of lipid peroxidation. Arginine supplementation dose should besmall, the speed should be slow and time should be short.