胰岛β细胞功能不全的创伤性MODS的实验诊断方案探讨  

Studies on the improved diagnostic standards of the trauma MODS involved islet β-cell dysfunction

作　　者：王占科[1] 雷万生[1] 刘学广[1] 汪仕良[2] 李光伟[3] 熊晓平[1] 许霖水[4] 王志[1] 

机构地区：[1]解放军第九四医院,江西南昌330002 [2]第三军医大学第一附属医院,重庆400038 [3]卫生部中日友好医院,北京100029 [4]第三军医大学基础部,重庆400038

出　　处：《中国实验诊断学》2006年第8期901-903,共3页Chinese Journal of Laboratory Diagnosis

基　　金：江西省卫生科技资助课题(20050244)

摘　　要：目的制订涉及胰岛β细胞功能不全的创伤性多器官功能不全综合征(MODS)诊断方案,早期诊断和发现创伤MODS。方法以我院近年来收治的重症监护室(ICU)创伤、包括大手术后2565例患者,包括198例创伤死亡患者为研究对象。在创伤MODS常规诊断方案基础上,补充胰岛β细胞功能不全指标(空腹血糖、HOMAβ、ΔINS30/ΔGLU30,等),制定涉及胰岛β细胞功能不全的创伤后MODS改良诊断方案。结果创伤或大手术后患者改良方案MODS诊断阳性率(12.51%)明显高于常规方案(8.85%),P<0.05。创伤死亡患者改良方案最终MODS诊断阳性率(87.37%)与常规方案(74.75%)无显著差别,P>0.05。创伤死亡患者改良方案死亡3天前MODS诊断阳性率(81.82%)明显高于常规方案(64.65%),P<0.01。结论将胰岛β细胞功能不全相关指标作为创伤后MODS诊断指标之一,可提高创伤MODS早期诊断率,但不会过度不合理扩大诊断范围。Objective To establish the improved diagnostic standards of the trauma MODS involved Islet β-cell dysfunction and to diagnosis the trauma MODS early. Methods Adding indexes of the Islet β-cell dysfunction to the routine diagnostic standards of the trauma MODS to establish the improved diagnostic standards of the trauma MODS involved in Islet β-cell dysfunction, and the 2565 eases of the trauma or postoperative patients,including 198 eases of the dead trauma patients had been studied.Results There were difference significantly of the percentages of positive diagnosis of trauma MODS in all the trauma patients between the improved MODS standards and roution standards（ 12.51% vs 8.85% ）. There was no differenee signifieantly of the percentages of positive final diagnosis of MODS in dead trauma patients between the improved and routine MODS standards（87.37% vs 74.75% ）, but there was differenee signitleantly of before dead 3 days in dead trauma patients between the improved and routine MODS stsndards（81.82% vs64. 65% ）. Conduslon The improved diagnostic standards of the trauma MODS involved Islet β-cell dysfunction can increase the percentages of positive diagnosis of MODS, and play a important roles on the early diagnosis of trauma MODS. The improved diagnostic standards do not diagnose the trauma MODS widely without reason.

关 键 词：创伤 多器官功能不全综合征 胰岛β细胞功能不全 诊断方案 

分 类 号：R641[医药卫生—外科学]