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外科侵襲の大きさによる骨格筋蛋白の全身蛋白分解に占める割合   :   INCREASED CONTRIBUTION BY SKELETAL MUSCLE TO THE RATE OF WHOLE-BODY PROTEIN BREAKDOWN ACCORDING TO THE SEVERITY OF SURGICAL STRESS 

作成者 田代, 亜彦, 山森, 秀夫, 高木, 一也, 森島, 友一, 中島, 伸之
作成者 (ヨミ) タシロ, ツグヒコ, ヤマモリ, ヒデオ, タカギ, カズヤ, モリシマ, ユウイチ, ナカジマ, ノブユキ
作成者の別表記 TASHIRO, Tsuguhiko, YAMAMORI, Hideo, TAKAGI, Kazuya, MORISHIMA, Yuichi, NAKAJIMA, Nobuyuki
キーワード等 3-Methylhistidine, Whole-body protein breakdown, Muscle protein breakdown, Surgical stress
日本十進分類法 (NDC) 490
内容 外科侵襲下における全身蛋白及び骨格筋蛋白分解速度および骨格筋の全身蛋白分解に占める割合いを検討した。65歳以下の男性成人患者35名を対象にし, 食道癌手術施行群(E群, n=13), 胃癌および大腸癌手術施行群(GC群, n=22)の2群に分けた。術前, 術後3, 10病日に^<15>N glycineの定速静注法により全身蛋白分解速度を測定した。尿中3-methylhistidine排泄量を測定し, Bilmazesらの式を用いて骨格筋蛋白分解量を算出した。また尿中総カテコールアミン及び総窒素排泄量を連日測定した。検索期間中は術前より絶食とし, アミノ酸1.5g/kg/day, 40kcal/kg/day投与する高カロリー輸液により管理した。全身蛋白分解はE群, GC群共術後第3病日に有意に増加し(E群でp<0.01, GC群でp<0.05), E群の増加はGC群より有意に高かった(p<0.01)。骨格筋蛋白分解は術前値0.54g/kg/day程度からは術後有意に増加し, 術後3病日でE群1.57土0.08g/kg/dayに(M±SE, p<0.01), GC群で0.93±0.03g/kg/day(p<0.01)となった。3病日での増加はE群でGC群より有意に高かった(p<0.01)。骨格筋蛋白分解が全身蛋白分解に占める割合は術前の22%程度から3病日ではE群40.7±1.5%(p<0.01), GC群32.6±1.8%(p<p.p5)と有意に増加し, E群ではGC群より有意に高かった(p<0.05)。以上, 外科手術後は, 全身蛋白分解, 骨格筋蛋白分解共に有意に増加し, 骨格筋の全身蛋白分解に占める比率は侵襲が大きいほど高かった。
A study was conducted to clarify the contribution by skeletal muscle to whole-body protein breakdown in surgically stressed patients. Thirty-five adult male patients younger than 65 years old were divided into two groups: one received esophagectomy (group E, 13 patients) and the other underwent gastric or colorectal operation (group GC, 22 patients). Whole-body protein breakdown was determined by constant infusion of 15N glycine. Urinary excretion of the total catecholamines and 3-methylhistidine (3-MH) were also measured. Skeletal muscle protein breakdown was calculated from 3-MH excretion according to Bilmazes. All of the patients were fed exclusively by TPN which provided 1.5g-protein and 40kcal/kg/day throughout the study. Urinary excretion of the total catecholamines increased significantly postoperatively, and the increases were significantly greater in group E. Whole-body protein breakdown increased significantly on the 3rd postoperative day in group E (p<0.01) and group GC (p<0.05). The increase was significantly greater in group E than in group GC (p<0.01). Muscle protein breakdown also increased significantly from 0.54 to 1.57±0.08 in group E (M±SE, p<0.01) and to 0.91±0.03g・protein/kg/day in group GC (p<0.01)on the 3rd postoperative day. The increase was also greater in group E than group GC (p<0.01). The percent of contribution by skeletal muscle to the whole-body protein breakdown increased significantly from 220f preoperative value to 40.7±1.5-1073756400n group E (p<0.01) and 32.6±1.8-1228203520n group GC (p<0.05) on the 3rd postoperative day. Percent contribution was significantly higher in group E when compared with group GC (p<0.05). In conclusion, the whole-body and skeletal muscle protein breakdown elevated postoperatively. Furthermore the contribution by skeletal muscle to whole-body protein catabolism increased proportionately with the severity of surgical stress.

公開者 千葉医学会
コンテンツの種類 雑誌掲載論文 Journal Article
ファイル形式 application/pdf
ハンドルURL http://mitizane.ll.chiba-u.jp/meta-bin/mt-pdetail.cgi?cd=00027786
ISSN 03035476
NCID AN00142148
掲載誌情報 千葉医学雑誌 Vol.71 no.4 page.307-313 (19950801)
フルテキストへのリンク http://mitizane.ll.chiba-u.jp/metadb/up/AN00142148/KJ00004213872.pdf
情報源 Chiba medical journal
言語 英語
著者版フラグ publisher


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