Обмен нуклеиновых кислот у больных с тяжелой ожоговой травмой, и возможности его коррекции

Abstract

Purpose. To assess changes in nucleic acid (NA) metabolism in severe burn injury and to develop recommendations for correction of the alimentary status taking into account changes in the NA metabolism. Materials and methods. All patients (37 patients with II–III degree thermal burns and a burn area of more than 40%) were divided into 2 groups: Group I included survivors (23 patients), group II consisted of the deceased. The intensity of the NA metabolism was assessed based on the dynamics of the of uric acid (UA) and oligonucleotides serum concentrations. Results. In the acute period of burn injury, marked decrease in UA levels (less than 100 μmol/l), with gradual stabilization in survivors is typical. In addition, a 2–3-fold increase in the concentration of serum oligonucleotides\xa0compared to the normal limit is typical for survivors in the acute period, and these changes were significantly different from the group of deceased patients starting from day 5. Taking into account the data obtained, the level of serum UA can be recommended in clinical practice for the assessment of alimentary status in burn disease, as well as a criterion for f the prescription of glutamine administration in critically ill patients. In patients with burn disease a decrease in the UA level to less than 100 μmol/l was regarded as an absolute indication for the use of L-glutamine products. The use of glutamine in patients with significant decrease in UA levels was accompanied by a significant increase in the intensity of NA metabolism, which was demonstrated by both an increase in uric acid levels (by 85% by day 10 after the start of glutamine administration, P<0.01) and restoration of repair processes. Conclusion. Therefore, there was a marked alteration of NA metabolism in both groups of patients with severe burn injury. At the same time, surviving patients are characterized by rapid recovery of NA metabolism. Glutamine was employed as a pharmacological agent that effectively abrogates the depression of NA metabolism.