6%羟乙基淀粉130/0.4影响肝硬化患者蛋白渗漏的作用机制  

Influence mechanism of 6% hydroxyethyl starch 130/0.4 on protein leakage in patients with liver cirrhosis

作　　者：张倩 黄绍艳[2] 王鲁甬 张建中[4] Zhang Qian;Huang Shaoyan;Wang Lu yong;Zhang Jianzhong(Binzhou Medical College,Yantai 264000,China;Department of Oncology,Yantaishan Hospital,Yantai 264008,China;Department of Anesthesiology,The Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Anesthesiology,Yantaishan Hospital,Yantai 264008,China)

机构地区：[1]滨州医学院,山东烟台264000 [2]烟台市烟台山医院肿瘤科,山东烟台264008 [3]青岛大学附属医院麻醉科,山东青岛266000 [4]烟台市烟台山医院麻醉科,山东烟台264008

出　　处：《山东第一医科大学（山东省医学科学院）学报》2021年第12期908-912,共5页Journal of Shandong First Medical University ＆ Shandong Academy of Medical Sciences

基　　金：烟台市科技计划(2019YD040);烟台市科技创新计划(2021MSGY048)。

摘　　要：目的探讨6%羟乙基淀粉130/0.4(6%Hydroxyethyl Starch130/0.4,HES)用于肝硬化患者后对蛋白的影响及作用机制。方法选择肝硬化腹水患者48例,随机分为两组,分别输入乳酸钠林格(A组)和HES(B组)。患者每天输入1次,共7日,输入量为血容量公式计算血容量的5%。输液前(T0)输液第7天结束后的24小时(T1)测定总蛋白(Total protein,TB)、白蛋白(human serum albumin,HSA)、尿素氮(urea nitrogen,BUN)、肌酐(creatinine,Cr)。HES输入人体后与HSA结合,荧光光谱法分析HES和HSA的结合关系,进一步研究HES对患者HSA的影响机制。结果两组相比,B组HSA(29.3±3.3)g/L、TP(57.4±4.3)g/L在T1时高于A组HSA(26.7±3.9)g/L、TP(53.9±4.5)g/L。HES加入到HSA后,HSA的二级结构发生变化。随着HES浓度增加,HSA的荧光强度降低,HES诱发HSA荧光猝灭,HES与HSA的Trp-214(Trp:色氨酸)形成1:1的结合物。结论HES减少肝硬化患者低蛋白血症的发生,与HES和HSA的Trp-214结合形成1:1复合物,体积增大,利于HES的机械堵漏。Objective:To investigate the influence mechanism of 6% hydroxyethyl starch 130/0.4 on protein in patients with liver cirrhosis patients.Methods:Fourty-eighty patients with liver cirrhosis were selected and divided into two groups randomly:sodium lactate ringer group(group A)and HES group(group B).The patients of group A were infused with 5% blood volume of sodium lactate ringer once a day for 7 days,and group B were infused with 5% blood volume of HES once a day for 7 days.TB,human serum albumin(HSA),BUN and CREA were measured at before infusion(T0),24 hours(T1 after the end of Day 7.When HES was infused into human body,and it was bound to HSA,and fluorescence spectroscopy analyzed the binding relationship between HES and HSA,and the effects of HES on proteins in patients were further studied.Results:Compared with group A,HSA(29.3±3.3)g/L and TP(57.4±4.3)g/L in Group B were higher than those in group A(26.7±3.9)g/L and TP(53.9±4.5)g/L at T1. The secondary structure of HSA was changed after HES was added.And as the concentration of HES increased,the fluorescence intensity of HSA decreased,HES induced HSA fluorescence quenching,and HES form a 1:1 structural binding relationship with tryptophan-214 of HSA.Conclusion:6% HES reduces the occurrence of low protein in patients with liver cirrhosis,and it binds with HES to form a 1:1 complex with Trp-214 amino acids,which increases the volume of HES in favor of mechanical plugging.

关 键 词：羟乙基淀粉 肝硬化 蛋白 渗漏 荧光 

分 类 号：R575.2[医药卫生—消化系统]