重度烧伤患者血浆凝溶胶蛋白水平变化的临床观察  

Clinical observation of the plasma gelsolin change in 98 patients with severe burn

作　　者：陈雪观[1] 方立曦[1] 李明农[1] 

机构地区：[1]嘉兴市第二医院烧伤科,浙江省嘉兴314000

出　　处：《中国基层医药》2016年第23期3642-3645,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：观察重度烧伤患者血浆凝溶胶蛋白水平的变化，探讨凝溶胶蛋白水平与患者预后的关系。方法采用前瞻性队列研究的方式，收集98例烧伤面积≥30％总体表面积（TBSA）患者作为研究对象；采用重复测量方差分析，比较不同分组患者血浆凝溶胶蛋白水平及变化趋势；采用 Logistic 回归模型分析血浆凝溶胶蛋白水平与患者并发脓毒症及因脓毒症死亡之间的关系。结果患者性别构成按不同烧伤面积分组差异无统计学意义（χ2＝2．371，P ＝0．306），是否脓毒症分组差异无统计学意义（χ2＝0．203，P ＝0．652），有无脓毒症患者预后差异无统计学意义（χ2＝0．462，P ＝0．479）。血浆凝溶胶蛋白水平随着烧伤面积的增大而下降，且相邻组间的下降差异均有统计学意义（均 P ＜0．001）；烧伤后7 d 血浆凝溶胶蛋白水平处于最低值，小于其它各时间点（均 P ＜0．001）。脓毒症患者血浆凝溶胶蛋白总体均数水平低于非脓毒症患者（F ＝1035．41，P ＜0．001）；烧伤后7 d 的血浆凝溶胶蛋白水平处于最低值，小于其它各时间点（均 P ＜0．001）。脓毒症死亡患者血浆凝溶胶蛋白总体均数水平低于存活患者（F ＝958．69，P ＜0．001）；烧伤后7～21 d 的血浆凝溶胶蛋白水平低于烧伤后3 d 及烧伤后24 h（均 P ＜0．001）。Logistic 回归分析显示，烧伤患者血浆凝溶胶蛋白水平与其并发脓毒症之间呈负相关（OR ＝0．873），与是否死亡之间同样呈负相关（OR ＝0．939）。结论烧伤可导致患者血浆凝溶胶蛋白水平降低，烧伤面积越大、合并脓毒症该指标越低；血浆凝溶胶蛋白水平可作为烧伤患者预后的预测指标。Objective To observe the change of immune response in patients with severe burn,and to explore the relationship between plasma gelsolin levels and the prognosis of patients.Methods This study described the epidemiological characteristics of a prospective cohort of 89 admitted severe burn patients had more than 30%TBSA.Compared the level and varation of plasma gelsolin in different groups using the method of repeated measures analysis of variance,and analyzed the relationship between plasma gelsolin level and burn sepsis and death with severe burns by Logistic regression.Results According to the burn area,burn sepsis and the prognosis,the differnces of the gender composition of the patients were statistically significant（χ2 =2.371,P =0.306;χ2 =0.203,P =0.652;χ2 =0.462,P =0.479）.Pairwise comparison results showed that the level of plasma gelsolin decreased as the burn area increased,and the decline between the two groups had statistically significant differences（all P 〈0.001 ）.7d after injury,the plasma gelsolin level was the lowest,which were less than other time points（all P 〈0.001 ）.The mean plasma gelsolin level of burn sepsis was lower than patients with no sepsis（F =1 035.41,P 〈0.001）.7d after injury, the plasma gelsolin level was the lowest,which were less than the other groups at each time point（all P 〈0.001）. Plasma mean gelsolin level of patients with sepsis death was low compared with the surviving patients（F =58.69,P 〈0.001）.7 ~21d after injury,the plasma gelsolin level was low compared with the 3rd and the 1st day of burn injury （all P 〈0.001）.Logistic regression analysis showed that burn plasma gelsolin level had a negative correlation with burn sepsis（OR =0.873）,so did burn death（OR =0.939）.Conclusion Burns can reduce the level of plasma gelsolin;the larger burn area,meanwhile with burn sepsis,the lower plasma gelsolin,so plasma gelsolin levels can be used as a predictor of prognosis.

关 键 词：烧伤 脓毒症 凝胶类 预后 

分 类 号：R644[医药卫生—外科学]