CAJ | 학술논문

目的通过监测多发创伤患者血清α-MSH和TNF-α的动态变化,探讨其与创伤患者病情的关系.方法山西医科大学第一医院急诊科收治的50例多发创伤患者根据ISS评分分两组,中重型(ISS 16～25分)30例,特重型(＞25分)20例,健康对照组15例.分别于伤后1、3、5、7d抽取静脉血,分离血清后采用酶联免疫吸附双抗体夹心(ELISA)方法测定血清α-MSH和TNF-α的含量.采用SPSS 13.0统计软件处理,多组均数间比较进行方差齐性检验和重复测量方差分析(Repetitive measure ANOVA),以P＜0.05为差异有统计学意义.结果两组创伤患者伤后24h内、3d、5d、7d血清α-MSH含量均显著低于健康对照组(P＜0.01),特重型组比中重组更加明显(P＜0.01)；两组患者伤后24 h内、3d、5d、7d血清TNF-α含量均显著高于健康对照组(P＜0.01),特重型组比中重组更加明显(P＜0.01)；伤后24 h、5d、7d血清α-MSH和TNF-α呈负相关.结论创伤后血清α-MSH含量下降且创伤越重下降越明显,血清TNF-α含量上升且创伤越重上升越明显,二者总体呈负相关.
목적 통과감측다발창상환자혈청α-MSH화TNF-α적동태변화,탐토기여창상환자병정적관계.방법 산서의과대학제일의원급진과수치적50례다발창상환자근거ISS평분분량조,중중형(ISS 16～25분)30례,특중형(＞25분)20례,건강대조조15례.분별우상후1、3、5、7d추취정맥혈,분리혈청후채용매련면역흡부쌍항체협심(ELISA)방법측정혈청α-MSH화TNF-α적함량.채용SPSS 13.0통계연건처리,다조균수간비교진행방차제성검험화중복측량방차분석(Repetitive measure ANOVA),이P＜0.05위차이유통계학의의.결과 량조창상환자상후24h내、3d、5d、7d혈청α-MSH함량균현저저우건강대조조(P＜0.01),특중형조비중중조경가명현(P＜0.01)；량조환자상후24 h내、3d、5d、7d혈청TNF-α함량균현저고우건강대조조(P＜0.01),특중형조비중중조경가명현(P＜0.01)；상후24 h、5d、7d혈청α-MSH화TNF-α정부상관.결론 창상후혈청α-MSH함량하강차창상월중하강월명현,혈청TNF-α함량상승차창상월중상승월명현,이자총체정부상관.
Objective To detect the variations of the serum α-MSH and TNF-α in multiple-trauma patients and discuss their role in severity of casualties.Methods Fifty casualties were divided into two groups for study.There were 30 casualties with moderate severe trauma(ISS 16 ～ 25 point)and 20 patients with extreme severe trauma(ISS ＞ 25 point),and another 15 healthy subjects were enrolled as controls.The blood samples were obtained within 24 hours,and 3 days,5 days,7 days after admission.The serum levels of α-MSH and TNF-α in casualties with multiple injuries were determined by using enzyme-linked immunosorbent double antibody sandwich method(ELISA).The data were expressed in((x)± s),and analyzed with chi-square test and repetitive measures of ANOVA by using SPSS 13.0 package.P value less than 0.05 indicated statistical significance Results The serum α-MSH levels of casualties within 24 hours,and 3 days,5 days,7 days after injury in the two groups were much lower than those in the control group (P ＜ 0.01),while the serum TNF-α levels of casualties were much higher than those in the control group (P ＜0.01).The serum α-MSH levels of casualties with extreme severe traumawere lower,and the TNF-αlevels of casualties with extreme severe trauma were higher than those in patients with moderate severe trauma(P ＜0.01,respectively).There were negative correlations between two biomarkers 24 hours,5d and 7d after injury.Conclusions In casualties,the serum levels of α-MSH decreased and the serum levelsof TNF-α increased,and the degrees of changes were closely depended on the severity of trauma,the more severe the more significant changes.There was a negative correlation between two biomarkers.