重症多发性创伤患者血浆凝溶胶蛋白水平动态变化的预后评估价值

Prognostic Value of the Dynamic Variety of Plasma Gelsolin Level in Patients with Severe Multiple Trauma

目的评估血浆凝溶胶蛋白(GSN)动态变化对重症多发性创伤患者预后结局判断的临床价值。方法选择我院就诊的67例多发性创伤患者,按创伤严重程度评分(ISS)分为:重症组:31例,ISS评分大于25分;轻症组:36例,ISS评分不大于25分。于治疗的第1、3、7、14d分别检测并比较两组的血浆GSN、降钙素(PCT)、肿瘤坏死因子(TFN-α)、超敏C反应蛋白(hs-CRP)及白介素(IL)-1。随访6月,比较两组的APACHEII评分以及阳性症状量表II(SAPSII)分值差异。依据预后结局分为:死亡组和生存组,比较两组上述指标的差异。应用多元Logistic回归分析上述指标与生存率的相关性。结果两组患者的TFN-α、hs-CRP及IL-1各时间点数值差异无统计学意义(P>0.05),两组血浆GSN均随着治疗时间增加而增加(P<0.05),而血清PCT随着治疗时间增加而降低(P<0.05)。与轻症组相比,重症组PCT、TFN-α、hs-CRP及IL-1水平在各时间均较高,而GSN水平在各时间均较低(P<0.05)。随访6月后,重症组APACHEII及SAPSII分值显著高于轻症组(P<0.05)。与死亡组相比,存活组GSN显著较高,而PCT、TFN-α及IL-1水平显著较低(P<0.05)。血浆GSN是重症多发性创伤患者生存率的保护性因素,而PCT及APACHEII是重症多发性创伤患者生存率的危险因素(P<0.05)。结论血浆GSN动态变化能有效评估重症多发性创伤患者预后结局。

Objective To analyze the clinical value of the dynamic variety of plasma gelsolin （GSN） level on the prognosis of patients with severe multiple trauma. Methods Sixty seven patients with multiple traumas were collected and divided into two groups according to the value of injury severe score （ISS）, which were severe group（31 cases, the ISS was more than 25 scores） and mild group（36 cases, the ISS was no more than 25 scores）. The values of GSN, PCT, TFN-α, hs-CRP and IL-1 were detected and compared between two groups at 1^st, 3^rd, 7^th, 14^th days respectively. At the time of 6 month follow up, the values of acute physiology and chronic health evaluation （APACHE） II and scale for the assessment of positive symptoms （SAPS） II were compared between two groups. Patients were also divided into two groups according to prognostic outcomes, which were death group and survival group. And the above indexes were also compared between these two groups. The risk factors of the above indexes and survival rate were analyzed by multivariate Logistic regression analysis. Results The values of GSN, PCT, TFN- ct and IL- 1showed no differences among all time- points in two groups （ P 〉 0.05 ）. And the plasma level of GSN was increasing as therapy was engaged, whereas serum level of PCT was decreasing. The values of PCT, TFN- or, hs- CRP and IL- 1 in severe group were higher than that of mild group at each timepoint （ P 〈 0.05 ）, but the plasma level of GSN in severe group was lower at each time- point （ P 〈 0.05 ）. At 6 month follow up, the values of APACHE II and SAPSII in severe group were higher than in that of mild group （ P 〈 0.05 ）. The value of GSN in survival group were higher than that of mild group, but the values of PCT, TFN-α and IL-1 in survival group were lower（ P 〈 0.05 ）. GSN was aprotective factor for survival, but the PCT and APACHE II were risk factors for survival （ P 〈 0.05 ）. Conclusion The dynamic variety of plasma GSN level might have effective prognostic value in patients with severe multiple trauma.