严重烧伤患者血浆凝溶胶蛋白水平及其与预后的关系  

Plasma gelsolin level and its relationship with the prognosis of patients with severe burns

作　　者：黄立锋[1] 姚咏明[1] 董宁[1] 贺立新[2] 张庆红[1] 于燕[1] 盛志勇[1] 

机构地区：[1]解放军总医院第一附属医院全军烧伤研究所,北京100048 [2]北京丰台右安门医院烧伤科

出　　处：《中华烧伤杂志》2013年第2期148-151,共4页Chinese Journal of Burns

基　　金：国家自然科学基金（30901561、30872683、81130035、81071545）;国家重点基础研究发展计划（2012CB518102）：伞军医学科学技术研究“十二五”计划重大项目（AWSlIJ008）

摘　　要：目的 观察严重烧伤患者血浆凝溶胶蛋白水平变化规律，探讨其与脓毒症和死亡之间的关系。方法 2010年5月—2012年5月，将2家笔者单位收治的102例烧伤总面积大于或等于30%TBSA的患者设为烧伤组，另设25名健康志愿者为健康对照组。分别于伤后1、3、7、14、21 d采集患者外周静脉血，双抗体夹心ELISA法检测血浆凝溶胶蛋白水平；同法取健康对照组人员血液行相同检测。（1）按烧伤总面积将烧伤组患者分为小面积（30%～49%TBSA）烧伤组39例、中面积（大于49%且小于或等于69%TBSA）烧伤组33例、大面积（大于69%且小于或等于99%TBSA）烧伤组30例；（2）根据烧伤脓毒症诊断标准，将烧伤组患者分为脓毒症组43例与非脓毒症组59例；（3）根据脓毒症患者的预后情况，将脓毒症组患者分为脓毒症死亡组14例与脓毒症存活组29例。比较各组患者血浆凝溶胶蛋白水平，分析其与患者并发脓毒症及死亡的关系。对数据进行方差分析、LSD检验、单因素Logistic回归分析。结果 （1）伤后1、3、7、14、21 d，烧伤组患者血浆凝溶胶蛋白水平均较健康对照组明显降低（F值分别为140.01、369.52、702.15、360.14、84.16，P值均小于0.01）。（2）大、中、小面积烧伤组患者血浆凝溶胶蛋白水平5个时相点均值分别为（43±11）、（85±23）、（124±38）mg/L，组间比较差异有统计学意义（F=367.76，P〈0.01），且均明显低于健康对照组的（326±51）mg/L（P值均小于0.01）。（3）脓毒症组、非脓毒症组患者血浆凝溶胶蛋白水平5个时相点均值分别为（77±12）、（122±38）mg/L，脓毒症组患者伤后3、7、14、21 d血浆凝溶胶蛋白水平显著低于非脓毒症组（F值分别为30.35、111.59、209.36、422.76，P值均小于0.01）。（4）脓毒症死亡组、脓毒症存活组患者血浆凝溶胶蛋白水平5个时相点均值分别为（53±8）、（103±25）mgObjective To observe the changes in plasma gelsolin （pGSN） level of patients with severe burn and to explore its relationship with sepsis and death of patients.MethodsOne hundred and two patients with total burn area equal to or larger than 30% TBSA hospitalized from May 2010 to May 2012 were included as burn group. Twenty-five healthy volunteers were recruited as healthy control group. Peripheral venous blood of patients was harvested on post burn day （PBD） 1, 3, 7, 14, and 21 to determine the pGSN level with double antibody sandwich ELISA kits, and the same maneuvor was carried out in healthy volunteers. （1） Patients in burn group were divided into three groups by burn size： small burn area group （30%-49% TBSA, n=39）, medium burn area group （larger than 49% and smaller than or equal to 69% TBSA, n=33）, and large burn area group （larger than 69% and smaller than or equal to 99% TBSA, n=30）. （2） According to diagnostic criteria of burn sepsis, patients in burn group were divided into sepsis group （n=43） and non-sepsis group （n=59）. （3） According to the prognosis of patients with sepsis, patients in sepsis group were further divided into non-survival sepsis group （n=14） and survival sepsis group （n=29）. The levels of pGSN in above groups were compared, and their relationship with sepsis and death of patients was analyzed. Data were analyzed with analysis of variance, LSD test and one-way Logistic regressions.Results（1） Levels of pGSN in burn group were obviously lower than those of healthy control group on PBD 1, 3, 7, 14, and 21 （with F values respectively 140.01, 369.52, 702.15, 360.14, 84.16, P values all below 0.01）. （2） The mean levels of pGSN in large, medium, and small burn area groups at five time points were （43±11）, （85±23）, （124±38） mg/L, showing statistically significant differences among them （F=367.76, P〈0.01）, and they were all lower than that of healthy control group [（326±51） mg/L, P values all below 0.01]. （

关 键 词：烧伤 脓毒症 预后 凝溶胶蛋白 

分 类 号：R644[医药卫生—外科学]