■带有嵌入金属碎片的伤口是武装冲突的不幸后果。在许多情况下,金属的确切身份及其长期健康影响,尤其是肾脏,不知道。
这项研究的目的是定量从手术植入的金属颗粒中溶解的金属的尿水平,并使用一系列生物标志物测定来评估这些金属对肾脏的影响。
■使用我们研究所开发的啮齿动物模型系统来模拟嵌入式碎片伤害,将八种被认为是嵌入碎片伤口的可能成分的金属分别植入雄性Sprague-Dawley大鼠的腓肠肌中。植入后对大鼠进行12个月的随访,在手术前收集尿液,然后在1,3-,6-,9-,和植入后12个月,以提供受试者内队列进行检查。使用电感耦合等离子体-质谱法测定尿金属水平,并使用市售试剂盒评估尿生物标志物以确定金属诱导的肾脏作用。
■除了少数例外,大多数植入的金属在植入后1个月迅速溶解,并在尿液中发现的水平明显高于对照动物。令人惊讶的是,与对照组相比,许多生物标志物在植入后1个月时降低,之后在较晚的时间点恢复正常.然而,两种金属,铁和贫化铀,在稍后的时间点显示几种标记物的水平增加,然而,随着时间的推移,这些水平也恢复正常。
■这项研究表明,通过手术植入Sprague-Dawley大鼠腿部肌肉的金属颗粒迅速溶解,尿液中发现了大量的植入金属。尽管肾脏生物标志物结果不一致,随着相对较低的金属注入量观察到的变化,建议在护理嵌入金属碎片伤口的个体时,需要考虑金属引起的肾脏影响。
BACKGROUND: Wounds with embedded metal fragments are an unfortunate consequence of armed conflicts. In many cases the exact identity of the metal(s) and their long-term health effects, especially on the kidney, are not known.
OBJECTIVE: The aim of this study was to quantitate the urinary levels of metals solubilized from surgically implanted metal pellets and to assess the effect of these metals on the kidney using a battery of biomarker assays.
METHODS: Using a rodent model system developed in our Institute to simulate embedded fragment injuries, eight metals considered likely components of an embedded fragment wound were individually implanted into the gastrocnemius muscle of male Sprague-Dawley rats. The rats were followed for 12 months post-implantation with urine collected prior to surgery then at 1-, 3-, 6-, 9-, and 12-months post-implantation to provide a within-subjects cohort for examination. Urinary metal levels were determined using inductively coupled plasma-mass spectrometry and urinary biomarkers assessed using commercially available kits to determine metal-induced kidney effects.
RESULTS: With few exceptions, most of the implanted metals rapidly solubilized and were found in the urine at significantly higher levels than in control animals as early as 1-month post-implantation. Surprisingly, many of the biomarkers measured were decreased compared to control at 1-month post-implantation before returning to normal at the later time points. However, two metals, iron and depleted uranium, showed increased levels of several markers at later time points, yet these levels also returned to normal as time progressed.
CONCLUSIONS: This study showed that metal pellets surgically implanted into the leg muscle of Sprague-Dawley rats rapidly solubilized with significant levels of the implanted metal found in the urine. Although kidney biomarker results were inconsistent, the changes observed along with the relatively low amounts of metal implanted, suggest that metal-induced renal effects need to be considered when caring for individuals with embedded metal fragment wounds.