创伤患者血清促红细胞生成素受体的动态变化与临床意义

Dynamic change of serum erythropoietin receptor and its clinical significance in trauma patients

目的探讨创伤患者血清促红细胞生成素受体(EpoR)的动态变化规律及可能的临床意义。方法检测47例创伤患者入院后0h、24h、7d血清EpoR水平,并记录对应生理指标(白细胞、血红蛋白、血糖),同时记录所有患者急性生理与慢性健康状况评分(APACHEⅡ),损伤严重度评分(ISS)及28d预后。根据损伤类型将患者分为脑损伤组和休克组,根据28d预后将患者分为存活组和死亡组。分析血清EpoR浓度的动态变化及组间差异。同时分析患者各时间点血清EpoR浓度变化与入院后0h的ISS、APACHEⅡ评分及生理指标(白细胞、血红蛋白、血糖)的相关性。结果脑损伤组与休克组血清EpoR浓度均为24h升至高峰,7d时仍维持在显著升高水平;休克组的血清EpoR浓度在24h、7d时间点均明显高于脑损伤组;中、重度脑损伤组血清EpoR浓度在各时间点均明显升高。死亡组7d EpoR浓度仍维持较高水平;死亡组血清EpoR浓度在0h、24h、7d均显著高于存活组。血清EpoR浓度在各时间点与ISS、APACHEⅡ评分、血糖水平呈正相关,在0、24h与白细胞水平呈正相关,在7d与血红蛋白呈负相关。结论 EpoR可作为评价创伤严重程度的有效指标,可反映病情的变化趋势,对判断预后具有一定的参考价值。

Objective To explore the dynamic change of serum erythropoietin receptor and its siginificance in trauma patients.Methods The concentration of serum erythropoietin receptor in 47 trauma patients was detected at 0 h,24 h and 7 d after injury.In the meantime,white blood cell（WBC）,hemoglobin,blood sugar were measured and recorded;injury severity score（ISS）,Glasgow coma score（GCS）,and APACHE Ⅱ at 0 h were also recorded.The patients were divided into brain injury group and shock group according to patients＇ injury type,and survival group and death group based on the 28 d outcome.The dynamic changes of serum erythropoietin receptor were observed and compared between the groups.The correlation of the serum erythropoietin receptor concentration with ISS,GCS,APACHE Ⅱ,WBC,hemoglobin and blood sugar was investigated.Results The serum erythropoietin receptor concentration in both shock and brain injury groups were increased after injury with the peak at 24 h,and stayed in high level at 7d.The serum erythropoietin receptor concentration in shock group was higher at 24 h and 7d compared with the brain injury group.The serum erythropoietin receptor concentration in moderate and severe brain injury groups were increased at all time points,the levels reached peak at 24 h.The serum erythropoietin receptor concentration in death group at 7 d was still high,while it was desceased in the survival group.The level in death group were higher than that in survival group at all time points.Conclusion The dynamic changes of serum erythropoietin receptor concentration in trauma patients can be used as a simple and effective marker to evaluate the severity of injury and predict the prognosis of patients.