创伤患者血清C-反应蛋白的变化及意义

Variation and Significance of C-Response Protein in Trauma Patients

目的探讨创伤患者血清C-反应蛋白水平的变化与病情变化的关系。方法50例创伤患者,根据ISS评分分为轻伤组和重伤组;重伤组根据有无并发症分组。测定入急救室即时及第2、4、7、10、14天晨血清C-反应蛋白、TNF-α和IL-8。同时记录体温、心率、呼吸、白细胞计数,取每天最低值进行SIRS评分。结果C-反应蛋白是一种急时相蛋白,伤后第2天即出现明显升高,C-反应蛋白的升高幅度与反应创伤严重程度的创伤评分相关。轻伤组及重伤无并发症组C-反应蛋白伤后第4天达峰值,后逐渐降低;重伤并发症组C-反应蛋白伤后持续升高,第7天达峰值,以后随病情好转下降。C-反应蛋白的变化与炎症因子SIRS等级评分都有相关性,但与SIRS的相关性更高。结论C-反应蛋白可以作为评估伤情严重程度和预后的客观指标。C-反应蛋白的变化可以反映病情的变化。综合分析C-反应蛋白、SIRS评分、炎症因子的变化更能把握患者病情的变化以指导临床治疗。

Objective To probe into the relationship between variation of CRP and severity of illness in multi-traumatic patients. Methods Fifty patients were divided into mild group and severe group according to ISS score and the severe group was separated by those with complications. Concentration of CRP, TNF-α and IL-8 were detected when they were admitted to emergency room as well as 2nd,4th,7th,10th and 14th day in the morning. Meanwhile, body temperature, heart rate, respiratory rate and leukocyte count, were recorded and SIRS scoring was made according to those parameter nadir. Results CRP was an acute phase protein. It increased obviously in two days after trauma and its increasing extent had correlation to trauma score revealing severtity of patients. Climax of CRP came on the 4th day after trauma and then decreased in the mild and severe patients without complication while it increased continuously and the peaking was on the 7th day in severe patients with complication, then decreased following the better illness states. Variation of CRP had correlation to ranking score of inflammtory factor and SIRS, but it had a better dependability to SIRS. Conclusion Concentration of CRP could be an objective index for evaluation of severity and prognosis in traumatic patients. Variation of CRP could reflect the change of illness in traumatic patients. General analysis of CRP,SIRS score and inflammatory factors could help us understand the patients＂ condition, which could guide our clinical therapy.