血清皮质醇、凝溶胶蛋白及C-反应蛋白与重症创伤患者病情、预后的关系  

Relationship between serum cortisol,coagulin and C-reactive protein and condition and prognosis of patients with severe trauma

作　　者：陈科伍 盛雷 梁建 郑佳燕 黄彪 袁朗 CHEN Kewu;SHENG Lei;LIANG Jian;ZHENG Jiayan;HUANG Biao;YUAN Lang(Department of Emergency Trauma,Dazu District People's Hospital,Chongqing 402360,China)

机构地区：[1]重庆市大足区人民医院急诊创伤科,402360

出　　处：《中国煤炭工业医学杂志》2023年第5期492-496,共5页Chinese Journal of Coal Industry Medicine

基　　金：重庆市科卫联合医学科研项目(编号:2022MSXM020)。

摘　　要：目的探究血清皮质醇、凝溶胶蛋白(CSN)及C-反应蛋白(CRP)与重症创伤患者病情、预后的关系。方法回顾性分析2020年2月—2022年5月该院收治创伤患者186例研究对象,按照创伤严重程度评分(ISS)分为轻症组99例(ISS≤25分)及重症组87例(ISS>25分)。比较不同创伤严重程度血清皮质醇、CSN、CRP及急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分,采用Pearson相关性分析皮质醇、CSN、CRP与APACHEⅡ评分、ISS评分的关系。比较不同预后基线资料及皮质醇、CSN、CRP。采用二元Logistic回归分析影响重症创伤患者预后的危险因素。结果重症组血清皮质醇、CRP及APACHEⅡ评分均显著高于轻症组,CSN水平低于轻症组(P<0.05)。皮质醇、CRP与APACHEⅡ评分、ISS评分均呈正相关;CSN与APACHEⅡ评分、ISS评分均呈负相关(均P<0.05)。预后良好组59例,预后不良好组28例。二组APACHEⅡ评分、ISS评分、肿瘤坏死因子-α、皮质醇、CSN及CRP水平比较,差异有统计学意义(P<0.05)。经二元Logistic回归分析结果显示,APACHEⅡ评分、ISS评分、肿瘤坏死因子-α、皮质醇、CSN及CRP是影响重症创伤患者预后的独立危险因素(P<0.05)。结论血清皮质醇、CSN及CRP与APACHEⅡ评分、ISS评分均有一定相关性,可监测重症创伤患者病情程度;且血清皮质醇、CRP水平升高,CSN水平降低,会增加重症创伤患者预后不良的风险。Objective To explore the relationship between serum cortisol,coagulin(CSN)and C-reactive protein(CRP)and the condition and prognosis of patients with severe trauma.Methods One hundred eighty-six trauma patients admitted to our hospital from February 2020 to May 2022 were retrospectively analyzed,and according to ISS score,they were divided into mild group of 99 cases(ISS≤25 points)and severe group of 87 cases(ISS>25 points).Serum cortisol,CSN,CRP and acute physiological and chronic health scoreⅡ(APACHEⅡ)were compared at different trauma severity levels,Pearson correlation was used to analyze the relationship between cortisol,CSN,CRP,APACHEⅡscore and ISS score.Baseline prognostic data and cortisol,CSN,CRP were compared.Binary Logistic regression was used to analyze the risk factors affecting the prognosis of patients with severe trauma.Results Serum cortisol,CRP and APACHEⅡscores in severe group were significantly higher than those in mild group,while CSN levels in severe group were lower than those in mild group(P<0.05).Cortisol and CRP were positively correlated with APACHEⅡscore and ISS score;CSN was negatively correlated with APACHEⅡscore and ISS score(P<0.05).There were 59 cases in good prognosis group and 28 cases in poor prognosis group.There were significant differences in APACHEⅡscore,ISS score,tumor necrosis factor-α,cortisol,CSN and CRP levels between the two groups(P<0.05).Binary Logistic regression analysis showed that APACHEⅡscore,ISS score,tumor necrosis factor-α,cortisol,CSN and CRP were independent risk factors for the prognosis of patients with severe trauma(P<0.05).Conclusion Serum cortisol,CSN and CRP are correlated with APACHEⅡscore and ISS score,which can be used to monitor the severity of patients with severe trauma;elevated levels of serum cortisol and CRP,while decreased levels of CSN,increase the risk of poor prognosis in patients with severe trauma.

关 键 词：皮质醇 凝溶胶蛋白 C-反应蛋白 重症创伤 

分 类 号：R641[医药卫生—外科学]