血清肌红蛋白和肌酸激酶评估多发伤预后的比较研究

Comparative study of serum myoglobin versus creatine kinase for evaluation of prognosis after multiple trauma

目的观察多发伤患者血清肌红蛋白（myoglobin，Mb）和肌酸激酶（creatinekinase，CK）水平与患者预后及肾功能衰竭的关系，比较两者在预后判断中的价值。方法检测41例多发伤患者（ISS≥16分）伤后1，3，7，14d血清Mb及CK浓度，同时记录伤后1d简化急性生理评分Ⅱ（simplifiedacutephysiologyscorel／，SAPS1I）、ISS、GCS，以及最终转归和有无发生肾功能衰竭。分析血清Mb、CK浓度与ISS、GCS、SAPSⅡ的相关性。使用受试者工作特征曲线（receiver0p·eratingcharacteristiccurve，ROC）分析并比较伤后1，3，7dMb及CK在预测多发伤患者转归及发生肾功能衰竭中的价值。结果血清Mb浓度在各时相点与SAPSⅡ均呈正相关，与ISS在7，14d呈正相关，而与GCS在3，7，14d呈负相关；血清CK浓度在3，7，14d与SAPSⅡ呈正相关，与ISS在7，14d呈正相关，与GCS在7，14d呈负相关。在用ROC判断患者预后中，伤后1，3，7d的血清Mb的曲线下面积分别为0．542，0．900，0．981；CK的曲线下面积分别为0．232，0．771，0．968。用ROC判断患者发生肾功能衰竭中，伤后1，3，7d的血清Mb的曲线下面积分别为0．864，0．949，0．955；CK的曲线下面积分别为0．480，0．889，0．939。结论血清Mb和CK在判断患者预后及发生肾功能衰竭时均有较好的价值，其中血清Mb的价值更高。

Objective To detect the correlation of serum myoglobin （Mb） and creatine kinase （CK） levels in multiple trauma patients with outcome and renal failure and compare the prognostic value of the two predictors. Methods Forty-one patients with multiple trauma （ISS 〉1 16 points） were ana- lyzed at days 1,3, 7, and 14 posttrauma, for serum Mb and CK concentrations. Moreover, simplified a- cute physiology score H （SAPS U ）, injury severity score （ISS）, as well as Glasgow coma score （GCS） at day 1 postrauma, final outcome, and presence or absence of renal failure were recorded. Correlation of serum Mb and CK with ISS, GCS, and SAPS 1/ was analyzed. Predictive values of Mb and CK for out- come and development of renal failure after multiple trauma were measured and compared at days 1, 3, and 7 posttrauma, according to receiver operating characteristic （ ROC ） curve. Results Serum Mb concentration revealed a positive correlation with SAPS 1I at each time point and with ISS at days 7 and 14, but a negative correlation with GCS at days 3, 7, and 14. Similarly, serum CK concentration presen- ted a positive correlation with SAPS II at days 3,7, and 14 and with ISS at days 7 and 14, but a negative correlation with GCS at days 7 and 14. To predict outcome of the multiple trauma patients, area under the ROC curve for serum Mb at days 1,3, and 7 was 0.542, 0. 900, and 0. 981 respectively and for serum CK was 0. 232, 0.771, and 0.968 respectively. To predict development of renal failure, area under the ROC curve for serum Mb at days 1, 3, and 7 was 0. 864, 0. 949, and 0. 955 respectively and for serum CK was O. 480, O. 889, and 0. 939 respectively. Conclusions Serum Mb and CK are both predictive of outcome and development of renal failure following multiple trauma. Whereas in contrast with CK, sermn Mb appears to be a more sensitive marker.