炎症因子PCT及IL-1β与成人多发伤和创伤并发症的相关性研究  

Relationship between inflammatory cytokines PCT,IL-1β and severe trauma complications in adults with multiple injuries

作　　者：岳东亚 朱景波 刘玉龙 YUE Dong-ya;ZHU Jing-bo;LIU Yu-long(Department of General Surgery,General Hospital of Yongmei Group,Yongcheng,Henan 476600,China)

机构地区：[1]永煤集团总医院普外科,河南永城476600

出　　处：《医药论坛杂志》2022年第17期54-57,共4页Journal of Medical Forum

摘　　要：目的 探讨降钙素原(PCT)、白细胞介素-1β(IL-1β)对多发伤患者伤情诊断及预测晚期脓毒症的临床价值。方法 收集2019年7月—2020年10月接诊于永煤集团总医院急诊创伤中心的多发伤患者94例,按入院时创伤严重程度(ISS)评分情况分为三组,轻度创伤组(9分≤ISS<15分)25例,中度创伤组(15分≤ISS<25分)37例,重度创伤组(ISS≥25分)32例。于创伤后6 h、12 h、24 h、48 h采血,检测血清PCT、IL-1β水平;比较3组不同时间点血清PCT、IL-1β水平,采用Spearman系数法分析PCT、IL-1β峰值与创伤严重程度的关系,并采用logistic回归模型分析PCT、IL-1β峰值与患者预后的关系。结果 随着创伤程度加重,患者入院时外周血中性粒细胞比例逐渐增高(P<0.05),住院时间逐渐延长(P<0.05),MODS发生率逐渐增高(P<0.05);患者血清PCT、IL-1β水平均逐渐增高(P<0.05);3组血清PCT、IL-1β水平在伤后6h处于高峰,之后逐渐降低。以早期PCT、IL-1β峰值(伤后6 h)进行Spearman相关分析显示,PCT、IL-1β峰值均与多发伤患者创伤严重程度呈正相关(r=0.383、0.412,P<0.05)。多因素logistic回归分析显示,血PCT(OR=1.19,95%CI:1.09~1.43,P=0.002)及IL-1β峰值(OR=1.14,95%CI:1.17~1.42,P=0.003)均是脓毒症的独立预测因子,而与MODS、死亡发生无明显相关性(P>0.05)。结论 伤后6 h血清PCT、IL-1β对多发伤患者伤情诊断有重要价值,并可作为脓毒症发生的重要预测因子。Objective To explore the clinical value of procalcitonin(PCT) and interleukin-1β(IL-1β) in the diagnosis of traumatic condition and the prediction of complications in patients with multiple injuries.Methods A total of 94 patients with multiple injuries who were admitted to the emergency trauma center of our hospital from July 2019 to October 2020 were collected,and they were divided into three groups according to the injury severity score(ISS) at admission,including 25 cases of mild trauma group(9 points ≤ISS <15 points),37 cases of moderate trauma group(15 points ≤ISS <25 points) and 32 cases of severe trauma group(ISS≥25 points).Blood was collected at 6 h,12 h,24 h and 48 h after trauma,and the levels of serum PCT and IL-1β were measured.The levels of serum PCT and IL-1β were compared among the three groups at different time points.Spearman coefficient method was used to analyze the relationship between peak values of PCT and IL-1β and trauma severity.Logistic regression model was used to analyze the relationship between peak values of PCT and IL-1β and prognosis of patients.Results With the aggravation of trauma,the proportion of peripheral blood neutrophil gradually increased at admission(P<0.05),the length of hospital stay gradually prolonged(P<0.05),and the incidence of MODS gradually increased(P<0.05).The serum PCT and IL-1β levels were increased gradually(P<0.05).The levels of serum PCT and IL-1β in the three groups peaked at 6 h after injury and gradually decreased afterwards.Spearman correlation analysis based on peak values of early PCT and IL-1β(at 6 h after trauma) showed that the peak values of PCT and IL-1β were positively correlated with the severity of trauma in patients with multiple injuries(r=0.383,0.412,P<0.05).Multivariate logistic regression analysis showed that the peak values of blood PCT(OR=1.19,95% CI:1.09-1.43,P=0.002) and IL-1β(OR=1.14,95% CI:1.17-1.42,P=0.003) were independent predictors of sepsis,but had no significant correlation with MODS and death(P>0.05).Conclus

关 键 词：多发伤 创伤伤情 降钙素原 白细胞介素-1Β 脓毒症 

分 类 号：R641[医药卫生—外科学]