烧伤患者血浆循环DNA水平的变化及其临床意义  

Change and clinical significance of plasma circulating DNA levels in burn patients

作　　者：刘潇[1] 任辉[1] 彭代智[2] 刘小玲[2] 何斌[2] 张宜澜[2] 钱卫[2] 李睿夫[2] 段小冬[2] 周灵[2] 

机构地区：[1]第三军医大学护理学院,重庆400038 [2]第三军医大学西南医院全军烧伤研究所,创伤,烧伤与复合伤国家重点实验室,重庆400038

出　　处：《第三军医大学学报》2014年第7期708-712,共5页Journal of Third Military Medical University

基　　金：国家科技支撑计划(2009BAI87B03);卫生行业科研专项项目(201202002)~~

摘　　要：目的观察烧伤患者血浆循环DNA水平的动态变化，探索血浆循环DNA在判断烧伤后伤情、病情及临床结局中的意义。方法纳人烧伤面积（BSA）〉30％的烧伤患者32例，其中男性25例，女性7例，平均年龄42岁。热力烧伤25例，化学烧伤7例。烧伤至入院中位时间为6．5h。分别于烧伤后1-3、4-7、8-14、15-21d收集血浆样本共108份，采用血浆DNA提取试剂盒提取血浆样本中的循环DNA，并用PicoGreen荧光染料法测定其浓度，分析其在烧伤病程中的变化规律。结合烧伤伤情（BSA、Ⅲ度烧伤面积、烧伤指数）、急性生理与慢性健康评分（APACHEII），以及多器官功能障碍综合征（MODS）评分，分析血浆循环DNA水平变化的临床意义。结果32例烧伤患者在入院第1次采血（烧伤后1-3d）的血浆循环DNA水平与BSA、烧伤指数、Ⅲ度烧伤面积、APACHEⅡ等伤情参数呈显著正相关（P〈0．01）。血浆循环DNA水平随烧伤后时间呈现出先略微抬升而后下降的规律，其中特重度烧伤组及死亡组患者入院时的血浆循环DNA水平分别显著高于同期的重度烧伤组、存活组（P〈0．01）。血浆循环DNA水平与患者MODS评分（P〈0．01）及多项临床与实验室指标（P〈0．05）显著相关。入院时血浆循环DNA水平、APACHEⅡ评分、MODS评分、BSA、Ⅱ度烧伤面积及烧伤指数皆与临床结局有显著的正相关。结论血浆DNA水平与烧伤伤情和病情的变化密切相关，有望作为烧伤后机体受损的严重程度指标与预后指标。Objective To observe the dynamic changes of plasma circulating DNA in burn patients and investigate its clinical significance. Methods According to clinical stages after burn, total 108 plasma samples were collected from 32 cases of burn patients （ burn surface area 〉 30% ） during post-burn days 1 - 3, 4-7, 8 -14, and 15 -21 respectively. They were subjected in March to July 2013, including 25 males and 7 females at a mean age of 42. Twenty-five patients were thermal injuries, and 7 were chemical burns with a median time of 6.5 h after injury. Plasma circulating DNA was extracted with QIAamp DNA Blood Mini Kit and quantified with Quant-iT PicoGreen fluorescent dye reagent. Combined with clinical data, plasma circulating DNA level was analyzed for its variation after burns and its clinical significance. Results Plasma circulating DNA levels in the first blood sample of 32 burn patients （taken within 1 -3 d after burns） had a significantly positive correlation with percentage of total body surface area （TBSA）, burn index, third degree burn area, and Acute Physiology and Chronic Health Evaluation lI （APACHE lI ） score （P 〈0.01 ）. Plasma DNA levels of burn patients presented a slight uplift firstly, and then a reduction as time went by. The patients with I〉50% TBSA burnt and those died had significantly higher DNA levels compared to the patients with 30% to 50% TBSA burnt and the survival patients respectively （P 〈 O. 01 ）. DNA levels were positively related to Multiple Organ Dysfunction Score （MODS） （P 〈 0.01 ） and some clinical and laboratory indicators （P 〈 0.05 ）. Plasma DNA level of first blood sample, APACHE Ⅱ score, MODS, burn surface area （ BSA）, third-degree burn areaand burn index on admission were all significant correlated with the clinical outcome. Conclusion Plasma DNA level is closely correlated with burn conditions and clinical processes, and might be regarded as a helpful indicator for burn severity and prognosis.

关 键 词：烧伤 循环DNA 血浆 严重程度 预后 

分 类 号：R362[医药卫生—病理学] R446.119[医药卫生—基础医学]