TTS评分联合TNF-α检测对胸部创伤患者不良预后的评估价值

Clinical study on the Expression of Inflammatory Factors and Classification of Thoracic Trauma Severity Score in Patients with Chest Trauma

【目的】探讨胸部创伤患者TNF—α表达水平和胸部创伤严重度评分（TTS）在患者早期病情预测和临床预后评估中的价值。【方法】选取2014年1月至2016年1月胸外科收治的胸部外伤患者64例。根据TTS评分（总分5～25分）分为重度组35例（A组，TTS评分16～25分）和轻度组29例（B组，TTS评分5～15分）。选择同期来本院进行健康体检者40例作为对照组（C组）。A、B两组于发病d1、d3、d7采集静脉血，均进行超敏C反应蛋白（hs—CRP）检测。采用ELISA法检测肿瘤坏死因子α（TNF-α）。并对三组均行动脉血气分析，测定pH、二氧化碳分压（PaCO2）、氧分压（PaO2）、血氧饱和度（Sa02）。C组仅采集一次静脉血，测定TNF—α，hs-CRP。比较各组间上述指标的变化。【结果】A组及B组患者伤后24～72h时hs—CRP和TNF—α水平进行性升高，且A组高于B组（〈0．05），但d7后开始回落。多器官功能障碍综合征（MODs）预测模型分析表明，TTS评分，发病24h以内的血清TNF-α水平及72h血清TNF-α水平均对胸部创伤患者MODS发生有预测价值。72h的血清TNF-α水平联合TTS评分对于其胸部外伤患者发生MODS预测价值最高（AUC=0．9089）。A、B两组患者的PH、PaCO2、PaO2、SaO2各项指标均与对照组存在显著差异，A组与B组间PaCO2、PaO2、SaO2也存在显著差异（均P〈0．05）。【结论】TTS评分能比较准确判断胸部创伤及呼吸功能程度，可以独立预测MODS的发生。TTS评分联合血清TNF-α水平检测，可以明显提高对患者发生MODs的预测值。

[ObjectiveITo study the relationship between the expression of inflammatory factors （like TNF-α） and classification of thoracic trauma severity score （TTS） in patients with thoracic trauma, and to investigate its role in the early prediction and assessment of clinical prognosis of patients. [MethodlSixty-four cases of hospital- ized chest trauma patients in Department of Thoracic Surgery of our hospital from January 2014 to January 2016 were selected for the study. According to the thoracic trauma severity score （TTS score, total score 5 - 25 points）, patients were classified as group A （35 severe cases with 16-25 points） and group B （29 mild cases with 5-15 points ）. At the same time period, 40 cases of healthy volunteers were selected as the control group （group C）. Collection of venous blood in group A and B were harvested on the onset of the first day, third day, and seventh day, and blood samples were collected in the control group as well at the same times. The inflammatory factors Hs-CRP and TNF-awere detected and arterial blood characteristics including pH,PaCO2 ,PaO2 and SaO2 concentrations in blood gas were monitored in all three groups. The ELISA method was used to detect the dynamic changes of TNF-α lpha index. Statistical software SAS9.3 was applied for data processing.[ResultslThe levels of hs-CRP and TNF-α in group A and group B showed a dynamic increasing within 24- 72 hours after injury. The changes in group A were dramatically higher than those in group B. Three single factors were found by the statistical analysis including TTS scores, the serum TNF- level within 24 hours of onset and serum TNF- levels on the third day. They had significant predictive value in thoracic trauma patients who suffered multiple organ dysfunction syndrome （MODS）.TTS scores combined with serum TNF-αlevels at 72 h showed the highest predictive value for thoracic trauma patients with MODS（AUC=0.9089）. Indicators of pH, PaCO2, PaO2 and SaO2 in group A and B were significantly different from the control group C, there were also significant differences between group A and B in terms of PaCOz, PaO2 and SaO2 （ P 〈0.05）.[Conclusion]The severity of chest trauma can be evaluated by the TTS scores. The prediction value of thoracic trauma patients with MODS occurring can be improved signifb cantly by the analysis of TTS scores combined with serum TNF-α levels.