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严重多发伤患者并发持续炎症-免疫抑制-分解代谢综合征的早期警示因子

Early risk factors for persistent inflammation immunosuppression and catabolism syndrome in patients with severe polytrauma

摘要:

目的:通过回顾性分析,研究严重多发伤患者伤后并发持续炎症-免疫抑制-分解代谢综合征(persistent inflammation, immunosuppression and catabolism syndrome, PICS)的早期警示因子,以期加深对严重创伤后慢性危重症病理变化的认识。方法:收集2019年3月至2020年12月间收治于同济医院创伤外科严重多发伤患者276例。入选标准:创伤严重度评分(injury severity score, ISS)≥27分,年龄≥18岁,住院时间>15 d。排除标准:既往有恶性肿瘤、免疫性、消耗性、代谢性疾病史的患者。收集患者的临床资料、ISS、格拉斯哥昏迷评分(Glasgow coma scale, GCS)、序贯器官衰竭评分、APACHE Ⅱ评分,以及伤后第3天的营养及免疫指标等资料,通过 t检验、 χ2检验或Mann-Whitney U检验比较组间差异,Logistic回归分析并发PICS的早期警示因子。 结果:并发PICS患者为PICS组(102例),不伴PICS的患者为N-PICS组(174例)。PICS组与N-PICS组相比,年龄偏大,伴发颅脑与胸部损伤多。在伤后第3天,PICS组IL-6、IL-10水平更高,Treg细胞比率更高,NK细胞计数和分类以及活化T淋巴细胞比率更低( P<0.05)。Logistic回归分析提示,年龄>65岁( OR=2.375,95% CI: 1.442~4.531)、同时伴有颅脑及胸部创伤( OR=2.846,95% CI: 1.522~5.361)、GCS≤8分( OR=3.431,95% CI: 1.843~8.512)、伤后早期IL-10>10 pg/mL( OR=2.173,95% CI: 1.751~5.614)、Treg细胞比率>7%( OR=3.871,95% CI: 1.723~6.312)是严重多发伤后并发PICS的早期独立危险因素。 结论:年龄>65岁、同时伴有颅脑及胸部创伤、GCS评分、伤后早期IL-10和Treg细胞比率可作为多发伤后并发PICS的早期警示因子。早期警示因子的发现将为早期甄别严重多发伤后潜在并发PICS的高危患者及早期采取干预措施创造可能。

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abstracts:

Objective:To retrospectively assess early risk factor of persistent inflammation, immunosuppression and catabolism syndrome (PICS) in patients with severe polytrauma, in order to deepen the understanding of the pathological changes of chronic critical illness (CCI) after severe polytrauma.Methods:A total of 276 patients with severe polytrauma admitted to Department of Trauma Surgery of Tongji Hospital from March 2019 to December 2020 were enrolled. Inclusion criteria included patients who suffered severe polytrauma, and injury severity score (ISS) ≥27, age ≥18 years old, and had length of hospital stay >15 days. Exclusion criteria included previous medical history of malignancy, or immunological, consumptive, and metabolic diseases. The patient’s clinical characteristics, ISS scores, Glasgow coma scale (GCS), sequential organ failure assessment, APACHEⅡ scores, and nutrition and immune indexes on day 3 after injury were collected. The difference between the PICS group and N-PICS group were performed by Student’s t test, χ2 test or Mann-Whitney U test. The early risk factors were assessed in patients with PICS after severe polytrauma by logistic regression analysis. Results:According to the diagnostic criteria of PICS, all enrolled patients were divided into two groups: PICS group ( n=102) and N-PICS group (without PICS, n=174). Compared with the N-PICS group, patients in the PICS group were older and associated with more brain and chest injuries. On the third day after injury, serum levels of IL-6 and IL-10, and the ratio of Treg cells were significantly higher, the number and ratio of NK cells subset, and the ratio of activated T lymphocyte were significantly lower in the PICS group than in the N-PICS group ( P<0.05). Logistic regression analysis showed that the age>65 years old ( OR=2.375, 95% CI: 1.442-4.531), GCS ≤8 scores ( OR=3.431, 95% CI: 1.843-8.512), IL-10 >10 pg/mL ( OR=2.173, 95% CI: 1.751-5.614), the ratio of Treg cells >7% ( OR=3.871, 95% CI: 1.723-6.312), and the occurrence of traumatic brain and chest injuries ( OR=2.846, 95% CI: 1.522-5.361) were the early risk factors in patients with PICS after severe polytrauma. Conclusions:Age>65 years old, GCS score, IL-10, the ratio of Treg cells, and the occurrence of traumatic brain and chest injuries could be used as the early risk factors in patients with PICS after severe polytrauma. The discovery of early risk factors will help identify patients at high risk of PICS after severe polytrauma, and create the possibility for early intervention.

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作者: 唐庭轩 [1] 唐良晟 [2] 陈登 [2] 邓海 [2] 罗家柳 [2] 常特定 [2] 杨净植 [2] 董黎明 [2] 唐朝晖 [2]
期刊: 《中华急诊医学杂志》2022年31卷5期 598-602页 ISTICPKUCSCD
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.1671-0282.2022.05.005
发布时间: 2022-07-31
基金项目:
国家自然科学基金 National Natural Science Foundation of China
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