严重多发伤患者并发症的预测和辅助诊断  

Prediction and Accesory Diagnosis of Infection Complication in Severe Multiple Trauma Patients

作　　者：徐祥[1] 梁华平[1] 杨文琼[1] 何义平[1] 罗艳[1] 王正国[1] 高劲谋[2] 都定元[2] 李邦春[2] 夏爱莲[2] 

机构地区：[1]第三军医大学大坪医院,重庆400042 [2]重庆市急救中心,重庆400014

出　　处：《中华医院感染学杂志》2002年第4期248-250,共3页Chinese Journal of Nosocomiology

基　　金：全军"九五"攻关课题资助项目

摘　　要：目的　研究严重多发伤患者血浆 TNF- α、IL- 6、IL- 10和 C-反应蛋白对伤后感染并发症的预测和辅助诊断价值。方法　应用 EL ISA法测定 34例 ISS≥ 16分的多发伤患者伤后血浆 TNF- α、IL- 6、IL- 10和 C-反应蛋白的变化 ,同时监控体温和血 WBC,并与 11例健康对照比较 ;应用 ROC曲线进行统计学处理。结果　伤后早期多发伤患者血浆 TNF- α、IL- 6、IL- 10和 C-反应蛋白出现不同程度升高 ;在伤后早期未并发感染前感染患者血浆 TNF- α、IL- 10、CRP以及体温和 WBC与非感染组相比无明显差异 ,待并发感染后则明显升高 ,而血浆 IL- 6在整个观察期间感染组均明显高于非感染组 ;对感染并发症的辅助诊断价值 ,CRP的灵敏度最高 ,体温和 WBC有较高的特异性和阴性预测值 ,IL- 6有较高特异性、阳性预测值和阴性预测值。结论　对多发伤伤后感染并发症的辅助诊断 ,这些指标均有一定的临床价值 ;IL- 6是最好的伤后感染并发症的预测和辅助诊断指标。OBJECTIVE To study the changes in TNF α, IL 6, IL 10 and CRP plasma levels and their value in predicting and assistantly diagnosing infection complications in severe multiple trauma patients. METHODS TNF α, IL 6, IL 10 and CRP were measured by enzyme linked immunosorbent assay (ELISA) in serial samples of plasma from 34 patients with severe multiple trauma (ISS≥16) and compared with those of 11 normal control volunteers. Body temperature and WBC counts were monitored at the same time. Patients were divided into two groups (infection and no infection groups), and differences of above parameters between groups were compared. In addition, all data were managed by receiver operating characteristic (ROC), and sensitivity, specificity, negative and positive predictive values of diagnosis in infection complications were calculated. RESULTS TNF α, IL 6, IL 10 and CRP plasma levels in multiple trauma patients were found increased to various degrees in the early posttrauma compared with those of healthy volunteers. Compared with those of patients without infection complication, TNF α, IL 10, CRP plasma levels, body temperature and WBC in the patients with infection complication were not different in the early posttrauma, but differences of above parameters between groups were observed after infection. However, IL 6 plasma levels in multiple trauma with infection were evidently increased through observed period. The value of those parameters in assistantly diagnosing infection was evaluated. Sensitivity of CRP was the highest, specificity and negative predictive value of body temperature and WBC counts were higher, while specificity, negative and positive predictive value of IL 6 were higher than others. CONCLUSIONS All the parameters have certainly clinical value in infection diagnosis after severe multiple trauma, of which IL 6 was the best sign in predicting and assistantly diagnosing infection occurred after multiple trauma.

关 键 词：多发伤 细胞因子 CRP 感染诊断 

分 类 号：R641[医药卫生—外科学]