多发伤患者血白介素-1β与份隋及并发症的关系

The association of blood IL-1β to injury and its complications in patients with multiple trauma

目的探讨白细胞介素-1β（interleukin-1β，IL-1β）水平的早期动态变化与多发伤患者伤情及其相关并发症的关系。方法收集2015年8月至2016年5月在上海市第六人民医院急诊科就诊的多发伤患者85例，排除标准：（1）烧伤、化学伤；（2）妊娠、绝经后女性；（3）1周前有细菌感染者；（4）合并慢性疾病患者。患者按照创伤严重程度评分（injuryseverityscore，ISS）分为3组，即轻微（22例，9≤ISS〈15）；中度（35例，15≤ISS〈25）和重度创伤组（28例，ISS〉125分）。收集患者创伤后第6、12、24、48、72h的静脉血，以免疫发光法检测血清IL-1β，采用单因素方差分析比较3组患者的年龄、住院天数等基本情况；比较3组患者在各时段IL-1β水平，运用多元Logistic回归分析IL-1β峰值与病情严重程度及其并发症的关系。结果（1）随着创伤程度的增加，患者住院天数显著延长、病死率以及多器官功能衰竭综合征（multipleorgandysfunctionsynduome，MODS）发生率显著增加（P〈0．05）。（2）中度和重度创伤组在各时段血IL-1β水平较轻微创伤组明显升高（P〈0．02）。（3）3组患者血IL-1β水平在创伤后6h达到高峰，随后开始下降。（4）IL-1β峰值是创伤严重程度（中度创伤组OR=1．21；95％C／：1．05—1．39，P=0．007；重度创伤组：OR=1．20；95％C／：1．03-1．40，P=0．019）和脓毒症（OR=1．28，95％C／：1．10—1．50，P=0．001）独立预测因子，但与MODS发生率及创伤病死率无显著关系。结论多发伤患者创伤后6h外周血IL-1β可以作为评估多发伤伤情及预测感染并发症的早期有效指标之一。

Objective To investigate the relationship between the dynamic changes of interleukin-1β （IL-1β） levels and severity and complications of patients with multiple trauma at the early stage. Methods Among 97 patients with multiple trauma in Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People＇ s Hospital between August 2015 and May 2016, 12 patients were excluded as follows, （1） with burns or chemical injuries; （2） pregnancy or menopausal women; （3） had bacterial infection a week ago; （4） with chronic diseases. The other 85 patients with multiple traumas were classified into three categories according to the injury severity score （ISS） . That is, the slight group （22 cases, 9 ≤ISS 〈 15 ） , moderate group （ 35 cases, 15 ≤ ISS 〈 25 ） and severe group （ 28 cases, ISS ≥ 25 ） . Theirvenous blood samples were collected at 6, 12, 24, 48 and 72 hours after trauma respectively, and the serum IL-1β levels were measured using a specific immunoluminometric assays. The basal conditions including age, the hospitalization days and so on among these three groups were compared via ANOVA. The mean IL-1βlevels at above time intervals among three groups were compared. Finally, the relationship between the peak concentration of IL-1β and injury severity and complications was analyzed by muhiple Logistic regression. Results （1） As the increasing severity of trauma, the patients with longer days of hospitalization and higher rate of multiple organ dysfunction syndrome （MODS） （ P 〈 0. 05 ）. （2） The levels of IL-1β in the moderate and severe groups were remarkably higher than those in the slight group （P 〈 0. 02）. （3） The IL-1β levels in each group peaked at 6 hours after trauma and began to decline. （4） Multivariate logistic analysis showed that peak concentration of IL-1β was still an independent predictor for injury severity （moderate group： odds ratio, 1.21 ; 95% confidence interval： 1.05 - 1.39, P = 0. 007; severe group： odds ratio, 1.20; 95% confidence interval： 1.03 - 1.40, P =0.019） and sepsis （odds ratio, 1.28 ; 95% confidence interval ： 1.10 - 1.50, P = 0. 001 ）, but had no significant association with MODS and trauma mortality even after controlling other risk factors. Conclusions The serum IL-1β at 6 hours after injury could be used as an early effective indicator to evaluate the injury severity and infection- related complications in patients with multiple trauma