烧伤儿急性相蛋白与脂肪乳剂凝集反应的研究及其临床意义

Fat agglutination and acute-phase proteins in pediatric burn patients: Clinical significance

为阐明烧伤病人血清急性相蛋白(acute-phase proteins,APP)及试管内脂肪乳剂凝集反应(fat agglutination,FA)的关系,于33例严重烧伤儿(年龄4个月～13岁)测定C-反应蛋白(C-reactiveprotein,CRP)、触珠蛋白(haptoglobin,HPG)、血沉(ESR)及FA。结果表明,烧伤休克期1例HPG增高、2例ESR增速,未见阳性FA。感染期CRP、HPG及ESR异常升高,除3例外均呈阳性FA。修复期CRP、HPG及ESR均恢复正常,无阳性FA。结论:严重烧伤儿感染期出现试管内阳性FA,血清APP及/或ESR升高。建议:为避免可能于血管内形成脂凝物,严重烧伤儿应用脂肪乳剂时必要采取预防性措施,最好于静脉输注前测定FA、APP及ESR。

To identify the changes in serum concentrations of acutephase proteins (APP) and in vitro fat agglutination (FA) in burn patients, we measured serum C-reactive protein and FA in 33 infants and children (age 4 months to 13 yrs) with severe burns. The results showed that HPG was increased in one patient and ESR in two pa- tients, but positive FA was not seen in any patients at the stage of shock. At the stage of infection, all but three were found to have a positive FA, howveer CRP, HPG and ESR were abnormally increased either singly or in combi- nation in all patients. While at the stage of restoration, CRP, HPG and ESR all became nomal, and no positive FA was noted. We conclude that in vitro FA occurs with con- comitant elevation of serum APP and/or ESR in infants and children with severe burns at the stage of infection. We suggest that precautions be taken to avoid possible in- trvascular fat agglutinate formation when using fat emul sion in severe burn patients. It is advisable to test FA or measure the levels of APP and ESR before intravenous fat infusion.