创伤失血性休克中炎性反应、APACHEⅡ评分及预后的相关性分析

Relationships between markers of inflammation, severity of injury, and clinical outcomes in traumatic hemorrhagic shock

目的研究血浆中炎性因子（IL-6，IL-10）、急性生理学及慢性健康状况评分（APACHEⅡ）评分和临床预后三者之间的相关性及其在预后评估中的价值。方法开滦医院2007年1月～2008年3月收治的患者中，选择严重创伤患者40例，年龄在16岁以上，进行创伤严重程度评分（ISS），分为2组：ISS≥40分为危伤组；20分≤ISS〈40分为重伤组；另设健康对照组，每组20人。血样采集，用以检测IL-6，IL-10；进行APACHEⅡ；监测并发症和最终临床预后。结果临床并发症在危伤组为50％，重伤组为20％。病死率分别为危伤组30％，重伤组10％。危伤组IL-6，IL-10水平，显著高于对照组（P〈0．01）；危伤组、死亡组的IL-6浓度和APACHEⅡ评分分别高于重伤组、存活组（P〈0．01）；危伤组和死亡组IL—10浓度分别与重伤组和存活组比较差异无统计学意义（P〉0．05）。在严重创伤患者中IL-6浓度与APACHEⅡ评分呈正相关（r=0．8726，P〈0．01），IL-10浓度与APACHEⅡ评分无相关性（1=-0．0615，P〉0．05）。结论早期检测血清IL-6浓度及APACHEⅡ评分对预见患者的病死率和逐渐发展的并发症，如脓毒症、急性炎性反应综合征和多器官功能衰竭有判断作用。

Objective This study was performed to investigate the relationship between serum cytokine levels （interleukin-6 [IL-6], interleukin-10 [IL-10]）, severity of injury and clinical outcomes, and to evaluate the predictive value of these markers for major complications and mortality in traumatic patients. Methods From January 2007 to May 2008, 40 patients older than 16 years who were admitted to the Affiliated Kailuan Hospital of North China Coal Medical College within 12 h after trauma, and who bad traumatic hemorrhagic shock （THS） at admission, were included in the present study. They were divided into three groups： the group of high-risk trauma （n=20）, ISS ≥40 scores; the group of severe trauma （n=20）, 20 scores ≤ ISS 〈 40 scores, and the healthy controls （n=20）. Demographic data were recorded for all subjects, and blood samples were taken for lactate, IL-6, and IL-10 measurements. The injury severity score （ISS）, the acute physiology and chronic health evaluation （APACHE Ⅱ） were calculated; complications and final clinical outcomes were monitored. Results Complications in 50% of the group of high-risk trauma and in 20% of the group of severe trauma. Mortality was 30% in the group of high-risk trauma and 10% in the group of severe trauma. Serum IL-6, IL-10 levels in the group of high-risk trauma were significantly higher than healthy controls （P〈0.01）. IL-6 levels, ISS scores and APACHE Ⅱ scores in the group of high-risk trauma and the non-survivors were higher than those in the group of severe trauma and survivors （P〈0.01）. There were no obvious significances in IL-10 levels between the group of high-risk trauma, the non-survivors and the group of severe trauma and survivors （P〉0.05）. Conclusion Early measurement of IL-6 and calculated APACHE Ⅱ scores in patients with trauma can be used to evaluate the state of illness and prognosis.