游离DNA、TNF-α对多发伤合并骨折患者发生MODS的预测价值

Predictive value of free DNA and TNF-α for MODS in patients with multiple trauma and fractures

目的探讨多发伤合并骨折患者外周血游离DNA、肿瘤坏死因子(TNF)-α水平变化对发生多器官功能障碍综合征(MODS)的预测价值。方法回顾性分析2016年5月至2019年5月南方医科大学深圳医院收治、受伤时间在24 h内的109例多发伤合并骨折患者的临床资料,按照MODS诊断标准将其分为MODS组(n=64)和非MODS组(n=45),另选择20例同期健康体检者为对照组,检测两组患者入院1、2、3 d及健康组外周血游离DNA和TNF-α水平。结果与健康组相比,MODS组和非MODS组患者外周血游离DNA和TNF-α含量均升高(P<0.05);入院后1、2、3 d MODS组上述指标均高于非MODS组,两组比较,差异有统计学意义(P<0.05);当游离DNA、TNF-α水平同时升高时,预测MODS的准确度最高,相对危险度为6.00,阳性预测值为99%。结论游离DNA、TNF-α可作为预测多发伤合并骨折患者并发MODS的指标,两者结合灵敏度和特异性更高。

Objective To explore the predictive value of changes of free DNA and tumor necrosis factor-alpha(TNF-α)levels in peripheral blood for multiple organ dysfunction syndrome(MODS)in patients with multiple trauma associated with fractures.Methods Clinical data of 109 patients with multiple injuries and fractures who admitted to Shenzhen Hospital of Southern Medical University from May 2016 to May 2019 were retrospectively analyzed,the time from onset to hospitalization of patients was all within 24 h.According to the diagnostic criteria of MODS,the patients were divided into MODS group(n=64)and non-MODS group(n=45).Another 20 healthy volunteers were selected as control group.The levels of free DNA and TNF-α in peripheral blood of the two groups at hospital day 1,2,3 as well as the results of the control group were detected.Results The levels of free DNA and TNF-α in peripheral blood in MODS group and non-MODS group were all higher than those in control group(P<0.05).At hospital day 1,2,3,the above parameters in MODS group were higher than those in non-MODS group,the differences between two groups showed statistical significance(P<0.05).When the simultaneous increase of free DNA and TNF-α was found in the same patient,the predictable accuracy for MODS was the highest with a relative risk of 6.00 and a positive predictive value of 99%.Conclusions Free DNA and TNF-α can be used as predictors of MODS in patients with multiple trauma and fractures.The combination of the two indicators could increase the sensitivity and specificity.