严重多发伤患者血小板膜糖蛋白的表达及其临床意义

Significance of platelet membrane glycoprotein in patients with severe multiple trauma

目的研究严重多发伤患者伤后血小板膜糖蛋白表达的变化，探讨其与病情严重程度、MODS的发生及预后的关系。方法将65例多发伤患者根据损伤严重度评分（ISS评分）分为严重多发伤组（ISS≥16分）和轻伤组（ISS〈16分），另设本院健康体检者30例为正常对照组。严重多发伤组根据是否发生MODS分为MODS组和非MODS组，根据预后情况分为生存组和死亡组。患者均在外伤后第1、3、7天采用流式细胞仪检测血小板膜糖蛋白CD62P、CD63的表达。结果轻伤组伤后第1、3天血小板膜糖蛋白CD62P、CD63表达显著高于正常对照组（均P〈005），在伤后第7天降至正常水平；严重多发伤组伤后第1、3、7天CD62P、CD63均显著高于正常对照组和轻伤组（均P〈0．01）。非MODS组CD62P、CD63表达在伤后第3天达高峰，第7天下降；MODS组CD62P、CD63表达在伤后第7天仍保持高水平，且在各个时点均明显高于非MODS组（均P〈0．01）；生存组CD62P、CD63表达在伤后第3天达高峰，第7天下降；死亡组在伤后第7天持续保持高水平，目在各个时点均明显高于生存组（均P〈005或0．01）。结论血小板膜糖蛋白表达与严重多发伤患者病情的严重程度、MODS的发生及预后相关。

Objective To investigate the changes of Platelet membrane glycoprotein in patients with severe multiple trauma, and to determine its relationship to severity of injury, incidence of MODS and prognosis. Methods 65 multiple trauma patients were divided into minor-injury group （ISS 〈 16） and severe -injury group （ISS≥16） .The severe-injury group was subdivided into MODS group and Non-MQDS group, survivor group and non-survivor group. The expression of CD62P, CD63 were measured by flow cytometry （FCM） on the 1,3, 7 day after injury. Results The expression of CD62P,CD63 in minor-injury group and severe-injury group were markedly higher than those in normal controller （P〈0.05 or 0.01）, and severe-injury group was remarkably higher than minor-injury group. The levels of CD62P and CD 63 were continuously rose in MODS group, and higher than those in non-MODS （P〈0.01）. The levels of CD62P and CD 63 were also continuously rose in non-survivor group, and higher than those in survivor group （P〈0.05 or 0.01）. Conclusion The expression of Platelet membrane glycoprotein is closely correlated with the severity of injury, which is probably helpful to predict the incidence of MODS and the prognosis.