摘要
目的：探讨创伤性凝血病患者血糖波动与血清炎症因子水平及预后的关系，为早期识别、预后判断和阐述发生机制提供新的方法或思路。方法选取创伤性凝血病患者100例，依据72 h内平均血糖波动幅度（ MAGE）分为A组（ MAGE＜3．9 mmol／L）61例、B组（ MAGE≥39． mmol／L）39例。检测24 h内凝血指标，包括凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（ TT）、纤维蛋白原（ Fg）、D－二聚体（ D－D）等，进行24 h内急性生理学及慢性健康状况评分Ⅱ（ APACHEⅡ）、创伤严重程度评分（ TRISS），监测72 h MAGE，检测第1、3、7天血清高敏C反应蛋白（ hs－CRP）、肿瘤坏死因子－α（ TNF－α）、白细胞介素－6（ IL－6）水平，观察4周内预后情况。对72 h MAGE与血清hs －CRP、TNF －α、IL －6水平进行Pearson直线相关分析，采用Logistic多因素回归分析各因素与患者死亡的关系。结果 B组24 h凝血功能包括PT、APTT、TT、Fg、D－D水平，24 h APACHEⅡ评分、TRISS评分及72 h MAGE水平均高于A组（ t＝3．40-5．52，P＜0．05或P＜0．01）。 A、B组血清hs－CRP、TNF－α、IL－6水平均以第3天最高，第7天降低，但低于第1天水平（t＝3．55-7．37，P＜0．05或P＜0．01）；B组血清hs－CRP、TNF－α、IL－6水平均高于A组相应时点水平（ t＝3．65-4．87，P＜0．05）。72 h MAGE与血清hs－CRP、TNF－α、IL－6水平均呈正相关性（rhs－CRP ＝0．62，rTNF－α＝0．49，rIL－6＝0．57，P＜0．05）。4周内A、B组致残率为26．23％、37．84％（χ2＝4．21，P＜0．05），死亡率为13．11％、35．14％（χ2＝5．07，P＜0．01）；多因素Logistic回归分析显示，APACHEⅡ评分、TRISS评分、72 h MAGE是创伤性凝血病患者死亡的独立危险因素。结论创伤性凝血病患者多存在较大幅度的血糖波动，且血清hs－CRP、TNF－α、IL－6呈高水平波动，72
Objective To explorer the relationship between glucose fluctuations with serum inflammatory factors and prognosis in patients with traumatic coagulopathy, to provide new method or idea for its early recognition, prognosis evaluation and expounding pathogenesis.Methods One hundred patients with traumatic coagulopathy were selected, and were divided into group A with 61 patients （MAGE〈3.9 mmol/L）, and group B with 39 patients （ MAGE≥3.9 mmol/L） by mean amplitude of glycemic excursions （ MAGE ） in 72 h.Coagulation indexes in 24 h were detected, including prothrombin time （ PT） , activated partial thromboplastin time （ APTT） , thrombin time （ TT） , fibrinogen （Fg）, D-dimer （D-D）, also acute physiology and chronic health evaluation （APACHEⅡ） and trauma revised injury severity score （ TRISS） in 24 h were measured, and MAGE in 72 h were monitored.Serum high sensitivity C -reactive protein （ hs -CRP ） , tumor necrosis factor alpha （TNF-α）, interleukin-6 （IL-6） level in day 1, 3, and 7 were detected, and patients＇prognosis were observed 4 weeks later.Relationship between 72 h MAGE with serum hs -CRP, TNF-α, IL-6 were analyzed by Pearson linear correlation, and relationship between patient＇s death and various factors were analyzed by Logistic multi-factors regression analysis.Results Coagulation indexes （ PT, APTT, TT, Fg, D-D） and APACHEⅡin 24 h, TRISS score in 24 h, and MAGE in 72 h in group B were all higher than that of group A （t=3.40-5.52, P〈0.05 or P〈0.01）.Serum hs-CRP, TNF-α, IL-6 in day 3 in group A and B were all in the highest level, and decreased in day 7, yet also lower than that in day 1 （t=3.55-7.37, P〈0.05 or P〈0.01）, and level in group B were all higher than that in group A on corresponding time point （t=3.65-4.87, P〈0.05）.72 h MAGE had positive correlation with serum hs-CRP, TNF-αand IL-6 （rhs-CRP =0.62, rTNF-α=0.49, rIL-6 =0.57, P〈0.05）. Disability rate in group A and B were 26.23%and 37.84%in 4 weeks aft
出处
《中国急救医学》
CAS
CSCD
北大核心
2015年第3期218-222,共5页
Chinese Journal of Critical Care Medicine
基金
重庆市卫生局科研项目（2012-2-267）
关键词
创伤性凝血病
血糖
炎症因子
相关性
发病机制
Traumatic coagulopathy
Blood glucose
Inflammatory factors
Correlation
Pathogenesis
