The study of myospecific markers, as well as enzymes, is an integral part in determining the clinical and pathogenetic aspects of the course of traumatic disease in patients with an increased body mass index. The purpose of the study was to analyze the dynamics of enzymatic activity and markers of rhabdomyolysis in patients with increased body mass index of polytrauma. Material and methods. We examined 224 patients with polytrauma with different starting body mass index figures in the period from 1 day to 1 year as to the levels of lactate dehydrogenase, lactate dehydrogenase-1, creatine phosphokinase, MV-fraction of creatine phosphokinase and myoglobin in serum. Results and discussion. Patients with increased body mass index of ≤29.9 were examined as to the state of enzymatic activity markers and markers of muscle damage on the background of traumatic disease with polytrauma, and the following features were revealed: lactate dehydrogenase hyperfarmentemia and creatine phosphokinase during the entire early traumatic disease period (the first to the fourteenth day of hospital stay); increased myoglobin level in the first days after receiving a polytrauma; restoring the numbers of its content in the blood from the 3rd day of treatment; the maximum numbers of lactate dehydrogenase-1 at admission followed by a gradual decrease and the achievement of control only a year after receiving injuries; finding the values of MV-fraction of creatine phosphokinase at the maximum level for admission with a probable excess of control figures by 1.5 times followed by a gradual decrease with control over the 3rd day by 10% and reaching its figure on the 7th day of treatment. Patients with the II-III degree obesity with a body mass index of 30.0-39.9, had the following features as to the state of enzymatic activity markers and markers of muscle damage on the background of traumatic disease in polytrauma: lactate dehydrogenase hyper-fermentemia during the first month from the moment of receiving polytrauma achieved control values the overwhelming number of patients only after a year; the numbers of creatine phosphokinase control in the blood are probably 40% higher on admission, its level exceeded on the 3rd day by 3 times and 14% of the starting values followed by a gradual decrease and control achieved one year after receiving a polytrauma; increased level of myoglobin in the first days after receiving a polytrauma; restoration of the numbers of its content in the blood from the 3rd day of treatment followed by undulating fluctuations within control values; the maximum numbers of lactate dehydrogenase-1 at admission followed by a gradual decrease and the achievement of control only a year after receiving injuries; finding the values of MV-fraction of creatine phosphokinase at the maximum level for admission with a probable excess of control figures by 2 times followed by a gradual decrease with control exceeding on day 3 by 14% and reaching its figure on the 7th day of treatment. Patients with morbid obesity with a body mass index of more than 40.0 showed the following features as tor the state of markers of enzymatic activity and markers of muscle damage on the background of traumatic disease with polytrauma: increase in lactate dehydrogenase hyperfermentemia during the entire observation period; the control numbers of blood CK exceeding by 5.3 times the admission parameters followed by the increase in the content of this indicator in the blood and an excess of its control level on the 3rd day by 8.6 times, on the 7th day by 5.5 times followed by a gradual decrease and achieve control one year after receiving polytrauma; the increase in the level of myoglobin in the first month after receiving a polytrauma; the restoration of the numbers of its content in the blood only after a year of observation; the maximum numbers of lactate dehydrogenase-1 at admission followed by a gradual decrease and the achievement of control only a year after receiving injuries; finding the values of MV-fraction of creatine phosphokinase at the maximum level for admission with a probable excess of control figures by 2 times followed by a gradual decrease with control parameters exceeding on day 3 by 14% and reaching its figure on the 7th day of treatment. Conclusions. The obtained data allow us to conclude that polytrauma leads to pronounced hyperfermentemia including in patients with increased body mass index. Thus, a traumatic disease in these patients is accompanied by a significant increase in the activity of serum markers of muscle damage during almost the entire observation period.
Keywords: myospecific markers, traumatic disease, patients with an increased body mass index, rhabdomyolysis
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