血清Lp-PLA2,BDNF及Ang1-7表达水平与血管性痴呆患者病情严重程度的相关性

目的 探讨血管性痴呆(VD)患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、脑源性神经营养因子(BDNF)及血管紧张素1-7(Ang1-7)表达水平及其与VD患者病情严重程度的相关性。方法 选取本院2017年10月-2019年10月收治的120例VD患者,依照简易精神状态检查量表(MMSE)分为轻度组、中度组和重度组,各40例,比较各组相关危险因素,颈动脉超声检测颈动脉内膜中层厚度(IMT),检测血清生化指标[低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、三酰甘油(TG)、糖化血红蛋白(GHb)、空腹血糖(GLU)]、血清指标[Lp-PLA2,BDNF,Ang1-7、神经元特异性烯醇化酶(NSE)、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、同型半胱氨酸(Hcy)]水平, 分析Lp-PLA2,BDNF及Ang1-7水平之间的相关性,也分析血清Lp-PLA2,BDNF及Ang1-7水平与MMSE评分的相关性。结果 3组患者年龄、受教育程度、高血压病史、高血脂症史、饮酒、吸烟等临床资料比较均无明显差异(P>0.05),冠心病史、糖尿病史、IMT比较均有明显差异(P<0.05); 3组患者血清LDL-C,HDL-C,TC,TG,GHb,GLU水平比较均无明显差异(P>0.05),血清Lp-PLA2,BDNF,Ang1-7,NSE,CRP,IL-6,TNF-α及Hcy水平比较均有明显差异(P<0.05)。相关性分析显示,血清Lp-PLA2,BDNF及Ang1-7与冠心病史、糖尿病史、血清NSE,CRP,IL-6,TNF-α,LDL-C,TC水平及MMSE评分存在明显相关性。结论 血清Lp-PLA2、BDNF及Ang1-7水平与血管性痴呆患者血清因子水平及VD患者的病情严重程度存在明显相关性,检测血清Lp-PLA2,BDNF及Ang1-7水平有助于VD患者的预防和治疗     

Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

BackgroundOpen pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.MethodsA query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher’s exact test and chi-square test for categorical variables, and Welch’s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.ResultsA total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.ConclusionWe report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.Level of EvidenceLevel II, Retrospective study.