摘要目的 探讨血清脂联素、高敏c-反应蛋白(Hs-CRP)与APACHE Ⅱ评分的变化在严重创伤患者病程监测中的意义.方法 采用酶联免疫(ELISA)法检测血清脂联素含量,采用免疫比浊法对血清Hs-CRP进行测定;选择80例严重创伤患者,按照入院时急性生理学和慢性健康状况评分(APACHEⅡ评分)分为轻度创伤组和重度创伤组,分别在入院的第1、3、5、7天动态检测血清脂联素和Hs-CRP浓度的变化,并同步进行APACHEⅡ评分,所得结果进行统计学分析.结果 患者入院时轻度创伤组与重度创伤组比较,血清脂联素和Hs-CRP含量水平差异有统计学意义(P<0.05).轻度创伤组患者Hs-CRP水平在第3天开始下降,APACHE Ⅱ评分也逐渐下降,血清脂联素水平在第5天开始上升.重度创伤组患者血清Hs-CRP水平以及APACHE Ⅱ评分虽经治疗仍持续上升,两组比较差异有统计学意义(P<0.01);重度创伤组患者血清脂联素水平虽经治疗仍持续下降,两组比较差异有统计学意义(P<0.01).同时严重创伤患者脂联素同Hs-CRP之间呈负相关(r=-0.69,P<0.01),同A-PACHE Ⅱ评分呈负相关(r=-0.63,P<0.01);严重创伤患者Hs-CRP同APACHE Ⅱ评分正相关(r＝0.61,P<0.01).结论 动态测定严重创伤患者血清脂联素和Hs-CRP水平结合APACHEⅡ同步评分,更有助于准确及时地评估病情和判断预后.

abstractsObjective To investigate the clinical significance of serum adiponectin, hs-CRP and APACHE Ⅱscore in evaluating the illness state for critical trauma patients. Methods The concentrations of adiponectin was measured by enzyme-linked immunosorbent assay(ELISA) , and hs-CRP was determined by rate nephelometry immunoassay. A clinical prospective serf-control trial was performed, in which 80 patients admitted to ICU by SIRS were enrolled. Objects were divided into mild and severe trauma group according to APACHE Ⅱ score. The adiponectin and hs-CRP concentrations were determined on the 1st, 3rd,5th and 7th day of admission , the APACHE Ⅱscore were assessed at the same time. Statistic analysis was performed according to this group. Results The concentrations of hs-CRP in severe trauma group was higher than those in the mild trauma groups on the 1st day (P<0.05). The concentrations of adiponectin in severe trauma group were lower than those in the mild trauma groups on the 1st day (P<0.05). The concentrations of hs-CRP in the mild trauma group began to decrease on the 3rd day,and the APACHE Ⅱscore began to decrease on the 5 th day too; and the concentrations of adiponectin began to increase on the 5 th day. The concentrations of hs-CRP and APACHE Ⅱscores in the severe trauma group concentrations kept increasing. The concentrations of adiponectin in the severe trauma group concentrations kept decreasing.There was negatively correlation between the concentrations of adiponectin and hs-CRP(r=0.69, P<0.01).There was negatively correlation between the concentrations of adiponectin and APACHE Ⅱscores(r=0.63, P<0.01 ). There was positive correlation between the concentrations of hs-CRP and APACHE Ⅱscores(r=0.61,P<0.01 ). Conclusions Dynamic measurement of adiponectin and hs-CRP concentrations with APACHE Ⅱscores provide great help to evaluate the illness state and predict the prognosis.