性别和年龄对复合伤后多脏器功能不全综合征和炎症细胞因子的影响

Impact of gender and age on multiple organ dysfunction syndrome and inflammatory cytokines after multiple injuries

目的探讨年龄和性别因素对复合性损伤后患者多脏器功能不全综合征(MODS)发生的影响及其可能的机制。方法观察本院2004～2007年期间ICU收治的78例复合性损伤患者的各项临床指标和MODS及败血症的发生率,并采用酶联免疫吸附法(ELISA)动态检测其血浆的TNF-α和IL-6水平,分析其与性别、年龄以及临床指标和MODS等之间的相关关系。结果(1)在相同的损伤严重程度评分(ISS)的前提下,女性患者MODS发生率明显低于男性患者(P<0.05),而年龄因素在本组资料中起着边缘性影响(P=0.06)。(2)MODS患者的血浆TNF-α和IL-6平均水平在损伤发生后的动态变化曲线与非MODS患者存在显著差异。其中在第1周内,相同ISS评分条件下,男性的血浆IL-6水平明显高于女性(P=0.04),但两周内的平均水平与女性患者无显著性差异(P=0.14)。结论性别对本组复合性损伤患者MODS的发生作用显著,年龄因素起着边缘性作用,但有待于进一步证实。

Objective To investigate the impact of age and gender on multiple organ dysfunction syndrome （MODS） after multiple injuries and the possible mechanism. Methods The clinical data of 78 patients with multiple injuries admitted in the ICU in our hospital from Jan. 2004 to Jan. 2007 were reviewed for age, gender, ISS, incidence of MODS, sepsis and mortality, days in ICU, and duration of ventilation. The plasma levels of TNF-α and IL-6 were examined by ELISA in the first two weeks after the injury, and the results were analyzed in relation to the demographic and clinical data. Results With similar ISS scores, the male patients were more likely to develop into MODS than the female patients （P〈0.05）, and age produced a marginal effect on the incidence of MODS （P=-0.06）. Compared with patients without MODS, those with MODS had a significantly different pattern of plasma TNF-α and IL-6 alterations. In the initial week following the injury, the male patients showed significantly higher plasma IL-6 levels than the female patients with the same ISS scores （P=0.04）, but the level alteration in the initial two weeks showed no significant difference between the male and female patients （P=0.14）. Conclusion Gender plays an important role in the occurrence of MODS following multiple injuries, but the effect of age on MODS seems only marginal and need to be further investigated.