肥胖对儿童烧烫伤预后的影响及MCP-1在其中的角色研究

Burn is one type of serious injuries, and it can lead to a series of problems such as skin necrosis, scars, dysfunction and disability, or even to death. Childhood burns not only bring pains to children themselves for a long time, but also harm their families, increase disease burden to the whole society. Up to now, childhood obesity has become a public health problem world widely. Previous studies showed that obesity could cause cytokines and metabolism changes, decrease immune function, and make the body more susceptible to infection, which may adversely affect the prognosis of burns. As a typical and important inflammatory cytokine, the exact effect of monocyte chemoattractant protein-1 (MCP-1), and whether it will be affected by obesity in the rehabilitation process in burned children are still unclear. In this study, we aim to use a cohort study to collect the children's general demographic data, obesity degree, burns-related information including the percentage of total burn surface area (TBSA) and the prognosis of burns, to explore the role and degree of obesity on the prognosis of childhood burns. We also prepare to use animal models by factorial design to explore and clarify the role and time effect between obesity and metabolism and MCP-1 on the prognosis in young burned rats. Our research can clarify the impact of obesity and MCP-1 on children's burns, and even to offer a pathway of giving a guide on the treatments, or predicting the prognosis in childhood burns especially for obese burned children.

烧烫伤对健康危害严重，轻者皮肤坏死留下疤痕，重者功能障碍和残疾，甚至导致死亡。儿童烧烫伤不仅给孩子自身带来无尽的痛苦，还会危害家庭幸福，增加社会的疾病负担。而儿童肥胖现已成为一种全球公共卫生问题，既往研究表明，肥胖可致细胞因子和代谢改变，引起免疫能力下降，使机体更加易于感染，这可能对烧烫伤的预后造成不利影响。单核细胞趋化蛋白1(MCP-1)作为炎症因子的典型代表，在烧烫伤儿童康复过程中的确切效应以及是否会受到肥胖因素的影响及程度大小尚不清楚。本研究通过队列研究方法，收集肥胖烧烫伤儿童和对照的一般人口学资料、肥胖情况、烧烫伤程度与预后情况等资料，探索肥胖对儿童烧烫伤预后的影响程度；并通过析因设计的动物模型探讨肥胖对烧烫伤大鼠代谢与MCP-1的影响及时间效应，阐明肥胖对儿童烧烫伤预后的影响及MCP-1在其中的角色。研究结果对阐明肥胖对儿童烧烫伤的影响，指导治疗及预测预后均有重要参考价值。

烧烫伤对健康危害严重，轻者皮肤坏死留下疤痕，重者功能障碍和残疾，甚至导致死亡。儿童烧烫伤不仅给孩子自身带来无尽的痛苦，还会危害家庭幸福，增加社会的疾病负担。而儿童肥胖现已成为一种全球公共卫生问题，既往研究表明，肥胖可致细胞因子和代谢改变，引起免疫能力下降，使机体更加易于感染，这可能对烧烫伤的预后造成不利影响。. 本项目在人群研究部分，通过现场调查并追踪随访及病历收集烧伤住院及门诊儿童600余例，获取烧伤儿童一般人口学资料、肥胖情况、烧烫伤程度与预后情况等资料，探索影响儿童烧烫伤预后的因素。结果发现烧伤儿童最主要的病因为热液(76.77%)，3岁以下最易发生(62.15%)，冬季高发(41.94%)，男童比女童更易发生。深Ⅱ°及以上的烧伤深度是瘢痕(HR=17.93)和肢体活动度(HR=8.14)的共同危险因素。TBSA和植皮术是烧伤儿童住院费用的影响因素。低年龄(HR=0.99)和植皮术(HR=0.34)是住院时长的保护因素。据此认为烧伤儿童的住院时间长，且费用较高。烧伤儿童的预后受年龄、性别、TBSA、深度、病因和植皮术等影响。. 动物实验部分，采用析因设计，将180只SD大鼠分别建立肥胖与烧伤模型，探讨肥胖对烧烫伤大鼠代谢与炎症因子的影响及时间效应，并采集1,3,7,14天的血液和皮肤样本，检测血清中炎症因子MCP-1、IL-1、TNF-α等表达量，计算不同时点创面愈合率，皮肤切片HE染色观察皮肤生长状况。结果发现：超重组和肥胖组大鼠在烧伤后对高代谢反应具有一定的适应和耐受能力；烧伤和肥胖对机体炎症反应具有相互促进的作用；肥胖程度不影响烧伤后创面的近期愈合状况，但对创面的远期愈合状况存在潜在的影响。. 结合人群与动物实验的研究结果，我们认为肥胖和烧伤对MCP-1为代表的炎症因子具有相互促进的作用；肥胖对创面的远期愈合状况存在潜在的不良影响。应对儿童尤其是低龄男童及其监护人进行烧伤安全知识与急救知识的宣传，减少烧伤的深度与面积对缩短住院时间，降低住院费用和改善烧伤的预后具有积极意义。研究结果对阐明肥胖对儿童烧烫伤的影响，指导治疗及预测预后均有重要的参考价值。