血清抵抗素和高敏C反应蛋白与急性生理学和慢性健康状况评分系统Ⅱ评分的变化在创伤患者病程监测中的意义

Significance of serum resisfin and APACHE H score for evaluating the severity of critical patients

目的探讨血清抵抗素、高敏C反应蛋白（Hs-CRP）与急性生理学和慢性健康状况评分系统（APACHEⅡ）评分的变化在创伤患者病程监测中的意义。方法选择80例创伤患者，按照人院时APACHEⅡ评分分为轻度创伤组（34例）和重度创伤组（46例），分别在人院的第1、3、5、7天动态检测血清抵抗素和Hs—CRP浓度的变化，采用酶联免疫吸附试验（ELISA）检测血清抵抗素含量，采用免疫比浊法对血清Hs-CRP进行测定；并同步进行APACHEⅡ评分，对所得结果进行统计学分析。结果患者入院时轻度创伤组与重度创伤组比较，血清抵抗素和Hs-CRP含量水平差异有统计学意义（P〈0．05）。轻度创伤组患者血清Hs-CRP水平在第3天开始下降，血清抵抗素水平在第5天开始下降，APACHEⅡ评分也逐渐下降；重度创伤组患者血清抵抗素和Hs—CRP水平以及APACHEⅡ评分虽经治疗仍持续上升，2组上述指标同时间比较，差异有统计学意义（P〈0．01或P〈0．05）。创伤患者血清抵抗素与Hs-CRP呈正相关（r=0．71，P〈0．01），与APACHEⅡ评分呈正相关（r=0．64，P〈0．01），Hs—CRP与APACHEⅡ评分呈正相关（r=0．61，P〈0．01）。结论动态检测创伤患者血清抵抗素和Hs．CRP水平结合APACHEⅡ同步评分，有助于准确及时地评估病情和判断预后。

Objective To investigate the clinical significance of serum resistin, Hs-CRP and APACHE Ⅱ score for evaluating the severity of patients. Methods The concentrations of resistin was measured by enzymelinked immunosorbent assay （ELISA）. Hs-CRP was determined by rate nephelometry immunoassay. A clinical prospective self-control trial was performed, in which 80 patients admitted to ICU by SIRS were enrolled. Objects were divided into mild and severe trauma group according to APACHE Ⅱ score. The resistin and Hs-CRP concentrations were determined on the 1st, 3rd and 5th day after admission and the APACHE Ⅱ score were assessed at the same time. Results The concentrations of resistin and Hs-CRP in severe trauma group were higher than those in the mild trauma groups on the 1st day （ all P 〈 0.05 ）. The concentrations of Hs-CRP in the mild trauma group began to decrease on the 3rd day and the concentrations of resistin began to decrease on the 5th day, meanwhile the APACHE Ⅱ score began to decrease too. The concentrations of resistin, Hs-CRP and APACHE Ⅱ scores in the severe trauma group concentrations kept increasing. There was a positive correlation between the concentrations of resistin and APACHE Ⅱ scores（ r = 0.64, P 〈 0. 01 ）. There was also a positive correlation between the concentrations of Hs-CRPand APACHE Ⅱ scores（ r = 0. 61, P 〈 0.01） , with also a positive correlation between the concentrations of resistin and Hs-CRP （ r = 0. 71, P 〈 0.01 ）. Conclusion Dynamic measurement of resistin and Hs-CRP concentrations with APACHE Ⅱ scores help evaluate the severity of critical patients.