白细胞介素-18的变化对创伤后脏器并发症的预警价值

Value of interleukin-18 changes in early warning of organ dysfunction after trauma

目的 研究创伤患者白细胞介素 (IL) - 18血浆水平的变化规律 ,并评估其对创伤后脏器并发症的预警价值。 方法 对 2 0 0 1年 3月～ 2 0 0 2年 9月收治的 5 4例创伤患者进行前瞻性研究 ,根据损伤严重度评分 (ISS)把患者分成低ISS(L -ISS)和高ISS(H -ISS)两组 ,在入院当天和第 4 ,7和 14天分别采集血标本 ,酶联免疫吸附法 (ELISA)测量IL - 18水平 ;此外 ,根据病历资料对发生全身炎症反应综合征 (SIRS)、脓毒症 (Sepsis)和多器官功能不全综合征 (MODS)患者的IL - 18血浆水平进行回顾性分析 ,计算其预警临界值。 结果 IL - 18在创伤后出现明显改变 ,在第 4 ,7天达到峰值、并在第 14天开始逐渐下降 ,其改变与创伤严重程度有关 ;发生脏器并发症的患者IL - 18血浆水平相对较高 ,伤后 7d内IL - 18的水平越高 ,则预示伤后的脏器并发症越严重。 结论 IL - 18可以作为一项预测创伤后脏器并发症的敏感指标。

Objective To detect the changes of interleukin-18 (IL-18) in plasma of trauma patients and evaluate their value in early warning of organ dysfunction. Methods A prospective study was carried out in 54 trauma patients admitted in from March 2001 to September 2002, which were divided into low injury severity score(ISS) group (Group L-ISS) and high ISS group (Group H-ISS). ELISA was applied to measure the level of IL-18 of blood samples that were collected on arrival, at days 4, 7 and 14 following admission. In the meantime, IL-18 level of plasma samples from patients with systemic inflammatory response syndrome (SIRS), sepsis and multiorgan dysfunction syndrome (MODS) was retrospectively analyzed so as to calculate the critical value of IL-18 in predicting organ dysfunction. Results After trauma, IL-18 concentration of plasma reached peak at days 4 and 7, and decreased gradually at day 14, which was significantly related to SIRS, sepsis and MODS, respectively. The IL-18 level was high relatively in plasma from patients with organ dysfunction. The higher IL-18 level in plasma within seven days after trauma indicated the severer organ dysfunction. Conclusion IL-18 is sensitive in early warning of organ dysfunction after trauma.