严重创伤后血清β-内啡肽与PMNs上CD18、CD54分子含量的变化

Levels of β-endorphin in serum and CD18, CD54 on PMNs in severely injured patients

目的 探讨严重创伤病人血清 β 内啡呔 ( β end)及外周血多形核粒细胞 (PMNs)CD18、CD5 4含量变化。方法 65例严重创伤病人按ISS分为两组 :ISS≥ 2 0分组 (n =3 6) ;ISS <2 0分组 (n =2 9)。使用放射免疫分析技术和流式细胞术分别检测 65例严重创伤病人入院时、伤后 1、3、7d血清皮质醇、β end浓度和PMNs上CD18、CD5 4的平均荧光通道变化 ,11例健康志愿者为对照组。结果 创伤病人血清皮质醇浓度在伤后2 4h内较对照组高 (P <0 .0 1) ,但创伤组间无差异。β end浓度在入院时达高峰 ,随后迅速下降 ,伤后第 72h恢复正常 ;伤后 2 4h内ISS≥ 2 0分组较ISS <2 0分组更高 (P <0 .0 5 )。PMNs上CD18、CD5 4含量在伤后各时相点与对照组比较差异显著 (P <0 .0 1) ;伤后最初 3d内 ,ISS≥ 2 0分组较ISS <2 0分组明显增高 (P <0 .0 1)。结论 β end、细胞粘附分子可能间接参与了创伤后PMNs的活化过程 ,其浓度和含量变化与损伤严重程度相平行 ;监测其动态变化有益于伤情评估。

Objective To investigate the changes of β endorphin (β end) in serum and cellular adhesion molecules (CAM) CD18 and CD54 on peripheral polymorphonuclear neutrophils (PMNs) in patients with severe injury. Methods Sixty five patients with severe injury were divided into ISS≥20 and ISS<20 group according to Injury Severity Score and 11 healthy volunteers (control group) were employed in this prospective study. On the 1st, 3rd and 7th d after injury, the concentrations of cortisol, β endorphin in serum and the levels of CD18, CD54 on PMNs were examined with radioimmunoassay and flow cytometry respectively. The results were compared with those of the control. Results Although the serum levels of cortisol were significantly higher in all patients than that in control within 24 h after injury (P<0.01), there were no statistical difference among 2 groups of trauma patients. The concentration of β end was at the peak when admited to hospital, then reduced rapidly and recovered to normal 72 h after the injury and the concentration of ISS≥20 group was higher than that of ISS<20 group (P<0.05). Significant difference was found in the levels of CD18, CD54 on PMNs in injured group and in control at every time points (P<0.01) and the levels was obviously higher in ISS≥20 group than in ISS<20 group in the first 3 d after injury (P<0.01).Conclusion These findings indicate that β end and CAM may participate indirectly in the activation of PMNs after trauma. The changes of β end level in serum and CAM concentration on PMNs are parallel to the severity of injury. It is beneficial to monitor the dynamic changes in assessing the severity injury.