中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
6期
579-582
,共4页
多发伤%血管生成素2%内皮损伤%创伤严重度评分%预后
多髮傷%血管生成素2%內皮損傷%創傷嚴重度評分%預後
다발상%혈관생성소2%내피손상%창상엄중도평분%예후
Multiple trauma%Angiopoietin2%Endothelial injury%Prognosis
目的 探讨多发伤患者早期血浆血管生成素2(angiopoietin2,Ang2)的水平变化与血管内皮损伤和预后的关系及临床意义.方法 为前瞻性观察研究,选择2008年1月至2010年1月收入聊城市人民医院急诊科的多发伤患者59例,纳入标准:创伤至入院时间在1 h以内;年龄大于18周岁;既往身体健康,排除有心、脑、肝、肾等器质性疾病,糖尿病、高血压,肿瘤;急慢性感染性疾病;严重颅脑损伤(GCS<12分);两周前用过抗凝及溶栓类药物患者.共纳入59例患者包括男36例,女23例,年龄(32.3±11.5)岁.按创伤严重度评分(ISS)分为重伤组(ISS≥16分,29例),轻伤组(ISS<16分,30例)2组.另取30例健康人为健康对照组,均为接受体检的健康人.其中男19例,女11例,年龄均大于18周岁,年龄(33.5±10.6)岁.各组性别、年龄构成均具有可比性.患者到达急诊科后10 min内抽取外周静脉血 10 mL,分离血浆.应用酶联免疫吸附法(ELISA)测定血浆Ang2的水平.同时测定血浆冯·维勒布兰德因子(Von Willebrand factor,vWF)、血栓调节蛋白(thrembomodulin,TM)的水平.统计数据用均数±标准差(-x±s)表示,所有数据采用SPSS 13.0统计软件进行统计分析.应用单因素方差分析和两两比较的Q检验(Newman-Keuls法)比较分析各组Ang2的水平差异.采用成组资料t检验比较分析死亡和生存患者Ang2的水平.采用pearson相关分析法分析Ang2水平与血浆vWF,TM的相关性.以P<0.05为差异具有统计学意义.结果 重伤组(ISS≥16分)血浆Ang2水平明显高于轻伤组(ISS<16分)(P<0.05),两组均明显高于正常对照组(P<0.05).死亡组血浆Ang2水平明显高于生存组(P<0.05).创伤后Ang2水平变化与血浆vWF,TM水平均有明显相关性(P<0.05).结论 血浆Ang2水平在多发伤早期明显增高,和创伤严重程度相关,和创伤后内皮损伤相关,其对预后有重要的预测价值.
目的 探討多髮傷患者早期血漿血管生成素2(angiopoietin2,Ang2)的水平變化與血管內皮損傷和預後的關繫及臨床意義.方法 為前瞻性觀察研究,選擇2008年1月至2010年1月收入聊城市人民醫院急診科的多髮傷患者59例,納入標準:創傷至入院時間在1 h以內;年齡大于18週歲;既往身體健康,排除有心、腦、肝、腎等器質性疾病,糖尿病、高血壓,腫瘤;急慢性感染性疾病;嚴重顱腦損傷(GCS<12分);兩週前用過抗凝及溶栓類藥物患者.共納入59例患者包括男36例,女23例,年齡(32.3±11.5)歲.按創傷嚴重度評分(ISS)分為重傷組(ISS≥16分,29例),輕傷組(ISS<16分,30例)2組.另取30例健康人為健康對照組,均為接受體檢的健康人.其中男19例,女11例,年齡均大于18週歲,年齡(33.5±10.6)歲.各組性彆、年齡構成均具有可比性.患者到達急診科後10 min內抽取外週靜脈血 10 mL,分離血漿.應用酶聯免疫吸附法(ELISA)測定血漿Ang2的水平.同時測定血漿馮·維勒佈蘭德因子(Von Willebrand factor,vWF)、血栓調節蛋白(thrembomodulin,TM)的水平.統計數據用均數±標準差(-x±s)錶示,所有數據採用SPSS 13.0統計軟件進行統計分析.應用單因素方差分析和兩兩比較的Q檢驗(Newman-Keuls法)比較分析各組Ang2的水平差異.採用成組資料t檢驗比較分析死亡和生存患者Ang2的水平.採用pearson相關分析法分析Ang2水平與血漿vWF,TM的相關性.以P<0.05為差異具有統計學意義.結果 重傷組(ISS≥16分)血漿Ang2水平明顯高于輕傷組(ISS<16分)(P<0.05),兩組均明顯高于正常對照組(P<0.05).死亡組血漿Ang2水平明顯高于生存組(P<0.05).創傷後Ang2水平變化與血漿vWF,TM水平均有明顯相關性(P<0.05).結論 血漿Ang2水平在多髮傷早期明顯增高,和創傷嚴重程度相關,和創傷後內皮損傷相關,其對預後有重要的預測價值.
목적 탐토다발상환자조기혈장혈관생성소2(angiopoietin2,Ang2)적수평변화여혈관내피손상화예후적관계급림상의의.방법 위전첨성관찰연구,선택2008년1월지2010년1월수입료성시인민의원급진과적다발상환자59례,납입표준:창상지입원시간재1 h이내;년령대우18주세;기왕신체건강,배제유심、뇌、간、신등기질성질병,당뇨병、고혈압,종류;급만성감염성질병;엄중로뇌손상(GCS<12분);량주전용과항응급용전류약물환자.공납입59례환자포괄남36례,녀23례,년령(32.3±11.5)세.안창상엄중도평분(ISS)분위중상조(ISS≥16분,29례),경상조(ISS<16분,30례)2조.령취30례건강인위건강대조조,균위접수체검적건강인.기중남19례,녀11례,년령균대우18주세,년령(33.5±10.6)세.각조성별、년령구성균구유가비성.환자도체급진과후10 min내추취외주정맥혈 10 mL,분리혈장.응용매련면역흡부법(ELISA)측정혈장Ang2적수평.동시측정혈장풍·유륵포란덕인자(Von Willebrand factor,vWF)、혈전조절단백(thrembomodulin,TM)적수평.통계수거용균수±표준차(-x±s)표시,소유수거채용SPSS 13.0통계연건진행통계분석.응용단인소방차분석화량량비교적Q검험(Newman-Keuls법)비교분석각조Ang2적수평차이.채용성조자료t검험비교분석사망화생존환자Ang2적수평.채용pearson상관분석법분석Ang2수평여혈장vWF,TM적상관성.이P<0.05위차이구유통계학의의.결과 중상조(ISS≥16분)혈장Ang2수평명현고우경상조(ISS<16분)(P<0.05),량조균명현고우정상대조조(P<0.05).사망조혈장Ang2수평명현고우생존조(P<0.05).창상후Ang2수평변화여혈장vWF,TM수평균유명현상관성(P<0.05).결론 혈장Ang2수평재다발상조기명현증고,화창상엄중정도상관,화창상후내피손상상관,기대예후유중요적예측개치.
Objective To investigate the early changes of plasma levels of angiopoietin2 in patients with multiple trauma and the relationship between plasma levels of angiopoietin2 (Ang2) and endothelial injury as well as prognosis of patients in order to determine their clinical significance. Methods Patients with multiple trauma admitted to emergency department from January 2008 to January 2010 were enrolled. A total of 59 casualties met the criteria(admission within 1 h after trauma and age > 18 years), and were eligible for enrollment. Patients with heart, brain, liver, kidney and other organic diseases, diabetes, hypertension, tumor, acute and chronic infectious diseases , severe brain injury (CCS < 12 points) , anticoagulant and thrombolytic medicine used two weeks before trauma were excluded. Among 59 patients, 36 were males and 23 females. The average age was(32.3 ±11.5) years. Patients were divided into severe trauma group (ISS ≥16 points,n =29) , moderate trauma group (ISS < 16 points, n =30 ) judged by using injury severity score (1SS). Thirty healthy subjects were selected as controls, 19 male and 11 female, with age > 18 years and an average age of(33.5 ±10.6) years. All groups had comparable gender proportion and average age. The 10 mL peripheral blood sanple was collected within 10 minutes after arrival of patients to emergency department and the plasma was separated from blood. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of angiopoietin2, and the plasma levels of von Willebrand factor (vWF) and thrombomodulin (TM) were also detected. Data were expressed as mean ± standard deviation and were statistically analyzed by using SPSS version 13.0 statistical software. The differences in plasma levels of angiopoietin2 of patients in each group were analyzed by ANOVA and Newman-Keuls test. Levels of angiopoietin2 in fatal patients and survival patients were also compared by using t test. The relationships between angiopoietin2 and plasma levels of vWF as well as levels of TM were analyzed by Pearson correlation analysis. Changes were considered as statistically significant if P value was less than 0.05. Results The plasma levels of angiopoietin2 in severe trauma group (ISS scored 16 points) were significantly higher than those in moderate trauma group (ISS < 16 points) ( P < 0.05 ), and those in trauma patients of the two groups were both significantly higher than those in control group (P < 0.05). The plasma levels of angiopoietin2 in fatal patients were significantly higher than those in survivors (P < 0.05). Plasma levels of angiopoietin2 were significantly correlated with plasma levels of vWF and TM (P < 0.05). Conclusions The plasma levels of angiopoietin-2 significantly increase after multiple trauma, and correlate with the degree of trauma severity. The plasma levels of angiopoietin2 correlate with endothelial injury after multiple trauma, having important prognosis value in patients with multiple trauma.
