血浆凝溶胶蛋白与绝经后妇女的髋部骨密度相关性研究

目的探索血浆凝溶胶蛋白(GSN)水平与中国人群的髋部骨密度(BMD)相关性。方法我院就诊的患者(55岁)为研究组(A组),按照是否患有骨质疏松症分为骨质疏松症组(OP组,BMD T评分≤-2.5)和BMD正常组(NBMD组,BMD T评分≥-1)两组;随后将所有女性患者分为小于70岁(B组)和大于70岁(C组)两组;检测血清指标和血浆GSN水平。结果 A组中,在总受试者(P=0.116)和男性及女性之间没有观察到血浆GSN水平的差异(P=0.977)。Pearson相关分析显示B组和C组的血浆GSN与BMD之间呈现负相关性(r=-0.19,P=0.018)。BMD与PINP(r=-0.35,P=0.002)、年龄(r=-0.38,P0.001)和BMI(r=0.70,P0.001)显著相关。GSN与BMD呈显著的负相关(r=-0.26,P=0.033)。结论血浆GSN与中国绝经后妇女的髋部BMD密切相关,血浆GSN可能是骨质疏松症的潜在风险生物标志物。     

严重烧伤患者血浆细胞因子水平与并发症的关系

严重烧伤患者血浆细胞因子水平与并发症的关系张飙杨奕王彦海田阳王景华田兆杰我们检测了烧伤患者血浆肿瘤坏死因子－α（ＴＮＦ－α）和白细胞介素－１β（ＩＬ－１β）含量，以分析它们与烧伤严重程度、烧伤后低血容量休克、脓毒症、多器官功能障碍综合征（ＭＯＤＳ）和...     

CD14基因多态性对严重烧伤后CD14表达的影响及其临床意义

目的探讨内毒素受体CD14C-159T基因多态性对烧伤后CD14合成与释放的影响及其与脓毒症易感性、患者预后的关系。方法26例烧伤面积大于30％的患者,采用聚合酶链反应及限制性内切酶HaeuI对PCR产物的消化作用检测CD14基因多态性。同时,对患者白细胞CD14、肿瘤坏死因子-α（TNF-α）mRNA表达,血清sCD14浓度与CD14-159位点基因型以及烧伤患者预后的关系进行了分析。结果Tr、TC、CC三种基因型患者白细胞CD14mRNA、TNF—amRNA表达,血清sCD14浓度存在明显差异。其中Tr、TC基因型CDl4mRNA表达均明显高于CC纯合子（P＜0．05或P＜0．01）,伤后第7天CC基因型血浆sCDl4水平显著低于TC基因型（P＜0．05）;同时,TT纯合子的TNF-αmRNA表达强度明显高于CC纯合子（P＜0．05）。此外,伤后第7、21天死亡组CDl4mRNA表达量显著高于存活组（P＜0．05）。结论CD14C-159T基因多态性可显著影响严重烧伤后CDl4的合成与释放,并与烧伤患者脓毒症易感性有关,T等位基因可能是患者预后不良的高危基因标志物。     

严重烧伤患者血浆IL-6、IL-8水平及其与感染的关系

严重烧伤治疗上的进展使疗效不断得到改善 ,但感染仍是烧伤患者死亡的主要原因。传统的治疗方法如合理应用有效广谱抗生素、早期切削痂植皮术以及营养支持疗法已很难使烧伤感染率有突破性的下降 ,这就促使人们寻求新的治疗方法来进一步预防和治疗烧伤感染。随着对烧伤病理生理研究的不断深入 ,人们逐渐认识到细胞因子在烧伤病理生理过程中起着非常重要的作用。目前已知参与这一过程的细胞因子主要有ＴＮＦ、ＩＬ - 1、ＩＬ - 2、ＩＬ - 6、ＩＬ - 8等 ,国内对ＴＮＦ、ＩＬ- 1、ＩＬ - 2等的研究较多 ,而对ＩＬ - 6、ＩＬ - 8在烧伤病理生理…     

烧伤患者血浆前列腺素E2和肿瘤坏死因子水平的变化

目的 观察探讨烧伤患血浆前列腺素E2（PGE2）和肿瘤坏死因子（TNFα）水平的变化,及其与烧伤程度、脓毒症之间的关系。方法 按不同烧伤面积和有无脓毒症分组并设正常对照,采用放射免疫分析法和酶联吸附试验法,检测患伤后不同时相点血浆PGE2和TNFα的浓度。结果 烧伤后大部分患血浆PGE2水平呈上升状态,但大面积烧伤和脓毒症患PGE2水平下降,甚至低于正常对照值;烧伤后患血浆TNFα水平升高,脓毒症时期表现更加明显,结果与烧伤面积和伤后时间无相关性。TNFα和PGE2水平之间呈负相关。结论 烧伤后血浆PGE2水平无均一性,PGE2水平下降容易发生脓毒症,PGE2对TNFα有下调作用。     

严重烧伤患者抗生素治疗时血浆内毒素水平的变化

目的 了解抗生素治疗过程中,严重烧伤患者血浆内毒素水平的变化. 方法选择50例烧伤面积大于30%TBSA的患者,分别应用临床上常见抗生素[分为奈替米星、头孢哌酮、头孢他啶、亚胺培南/西司他丁(业胺培南)组]常规治疗.采用偶氮基质显色法,检测抗生素治疗前后患者血浆内毒素水平. 结果奈替米星、头孢哌酮和头孢他啶组患者给药后,血浆内毒素水平有不同程度升高.其中头孢哌酮组先升高后下降,用药后第1、2天明显高于第3、5、7天(P＜0.05),同时明显高于亚胺培南组(P＜0.05).头孢他啶组用药后第5天内毒素水平达高峰(0.398±0.172)EU/mL,明显高于用药前[(0.251±0.142)EU/mL,P＜0.05],也明显高于奈替米星组、头孢哌酮组和亚胺培南组(P＜0.05).亚胺培南组用药后第1、2天血浆内毒素水平明显低于用药前. 结论不同抗生素治疗严重烧伤患者可诱导不等量的内毒素释放,临床用药应注意药物本身对内毒素水平的影响.     

严重烧伤与全身炎性反应综合征

目的提高对严重烧伤与全身炎性反应综合征（ＳＩＲＳ）的认识。方法１９９３年４月至１９９５年１２月对烧伤面积大于５０％的住院患者ＳＩＲＳ的发生及其全病程、死亡原因进行分析，同时对成活患者及死亡患者血清中细胞因子及免疫学指标进行比较。结果（１）ＳＩＲＳ最早发生在烧伤后２２小时，高峰期为烧伤后３～７天。（２）发生ＳＩＲＳ的死亡患者血清中ＴＮＦ明显高于成活患者，而粒细胞集落刺激因子、ＩｇＧ、Ｃ３、白细胞吞噬功能低于成活患者。（３）发生ＳＩＲＳ的患者胃粘膜ｐＨｉ低。（４）ＳＩＲＳ患者若继发感染，可发展为多器官功能障碍综合征（ＭＯＤＳ），死亡率明显增高。结论严重烧伤后，炎性介质大量释放，一旦产生失控，最终发展为ＭＯＤＳ。应在器官支持的前提下，在抗感染的基础上，纠正氧代谢障碍，进行免疫调理等综合性治疗，防止ＳＩＲＳ发展为ＭＯＤＳ。     

糖皮质激素在烧伤脓毒症骨骼肌蛋白代谢中作用的研究

目的　探讨糖皮质激素在烧伤脓毒症骨骼肌蛋白代谢中的作用及其机制。　方法　大鼠随机分为 4组 ,每组 1 5只 :B组大鼠 30 %Ⅲ度烫伤后立即腹腔注射内毒素 6mg/kg,模拟烧伤脓毒症 ;C组于伤前 2h ,D组于伤后 2h分别使用糖皮质激素受体拮抗剂RU38486灌胃 (1 0mg/kg) ,余处理同B组 ;A组为假伤组 ,并使用等量的生理盐水替代内毒素。伤后 1 2h ,测定血浆皮质醇浓度 ,称重和离体有氧孵育伸趾长肌 ,高效液相色谱法测定肌组织蛋白降解率 ,Northern杂交检测伸趾长肌泛素、E2 1 4kDa和C2mRNA的表达变化。　结果　伸趾长肌重量 ,B组较A组明显降低 ,差异有显著意义 (t=9 0 3 ,P <0 0 1 ) ;而C组和D组虽然低于A组 ,但显著高于B组 ,差异有显著意义 (t=2 2 6 ,6 42 ,P <0 0 5或P <0 0 1 )。血浆皮质醇浓度 ,B ,C和D组都明显高于A组 ,差异有显著意义 (t=9 0 3 ,2 2 94,P <0 0 1 )。蛋白降解率 ,B组总蛋白和肌纤维蛋白降解率较A组分别升高 58 8% (2 1 0 / 357)和335 5 % (4 1 6/ 1 2 4 ) ,差异有显著意义 (t=36 99和t=46 1 9,P <0 0 1 ) ;C组总蛋白和肌纤维蛋白降解率较B组分别减少 2 8 3 % (1 61 / 567)和 49 6 % (2 68/ 5 40 ) ,D组较B组分别减少 1 8 9% (1 0 8/ 567)和2 3 2 % (1 2 5/ 5 40 ) ,差异有显著     

The association between plasma gelsolin level and prognosis of burn patients

ObjectiveTo observe the change in plasma gelsolin levels among burn patients, and explore its impact on patient prognosis.MethodsThis prospective cohort study includes 98 burn patients with burns ≥30% TBSA, who were admitted to our institution between January 2010 and June 2013. Patients were grouped according to burn sizes, development and severity of sepsis, and survival from sepsis. The plasma gelsolin levels among different groups were compared by repeated measure ANOVA. The relationship between plasma gelsolin levels and the presence of sepsis and prognosis was examined by logistic regression.ResultsThe plasma gelsolin levels decreased with increasing burn sizes and increasing sepsis severity, with the lowest gelsolin level observed at 7 days after the burn. The plasma gelsolin concentrations were significantly lower among patients with sepsis than those without (P < 0.001), and were lower among those who died after sepsis than those who survived (P < 0.001). Logistic regression suggested that plasma gelsolin level was inversely associated with the occurrence of sepsis [OR 0.873 (95%CI 0.693–0.993)] and survival after sepsis [OR 0.939 (95%CI 0.859–0.992)].DiscussionPlasma gelsolin levels decrease after burn. The level is significantly lower among those with large burns and those with combined sepsis. Plasma gelsolin levels can be used to predict the prognosis of burn patients.     

Antithrombin deficiency and its relationship to severe burns

Antithrombin (AT) is an important endogenous anticoagulant and exhibits marked anti-inflammatory properties. To evaluate the incidence of AT deficiency in severe burn and its correlation to the variables of the abbreviated burn severity index (ABSI), length of hospital stay (LOS) and mortality we collected data on the substitution of human plasma-derived AT concentrate in 201 consecutive patients suffering from severe burn. One hundred and eight patients (54%) developed AT deficiency during their hospitalisation and, according to our institutional practice, received substitution therapy by continuous infusion to maintain physiological plasma activity (70-120%). The mean administered dose served as a measure of AT deficiency. The percentage of patients in an AT deficient state was highest within the first 5 days after injury. It was 26% on day 1 and between 38% and 41% on days 2-5 and thereafter decreased constantly over time. A multiple regression analysis between the dependent variable mean administered dose of AT concentrate and the independent variables age, total body surface area burned (TBSA), gender, inhalation injury (INHAL), full thickness burn (FTB), LOS and mortality was performed. Age, gender and FTB showed no significant influence on the development of AT deficiency. Increasing TBSA and INHAL clearly increase the risk of developing AT deficiency (p-values 0.0001 and 0.037). The analysis also identified AT deficiency as an independent predictor of LOS and mortality (p-values 0.036 and 0.003). Development of AT deficiency is a frequent event after burn with significant correlation to TBSA and INHAL, increased mortality rates and longer hospital stays.     

Time course of CD marker expression in patients with burns and its prognostic value

Introduction

Due to immune suppression sepsis has remained the leading cause of mortality after burns. CD marker expression in circulating blood has not been fully examined in humans. The aim of our study was to asses CD marker expression after burns and to compare it between survivors and non-survivors.

Patients and methods

Blood samples from all patients (n = 35) receiving intensive care treatment with more than 20% burned surface area were collected on admission and 5 consecutive days thereafter. Expressions of CD11a, CD11b, CD18, CD49d, CD97 and CD14 were measured on granulocytes, lymphocytes and monocytes.

Results

Expressions of granulocytes CD11a (days 1–2), CD18 (day 1), lymphocytes CD11a (days 1–5), CD11b (days 2–4), CD18 (days 1–6), CD49d (days 1–6), CD97 (day 1), monocytes CD11a (days 1–6), CD11b (day 2 and 5–6), CD18 (days 1–6), CD49d (days 1–6), CD97 (days 1–2), and CD14 (days 4–6) were significantly lower in patients than in healthy controls.Expressions of granulocyte CD11a (days 3–6), lymphocytes CD11a (days 3–6), CD11b (days 4–6), CD18 (days 4–6), monocyte CD97 (days 3–6) were significantly higher in survivors (n = 20) than in non-survivors (n = 15).

Conclusion

These results suggest that burns is associated with immunosuppression and overwhelming anti-inflammatory processes may be signs of bad prognosis.     

重度烧伤患者血清白细胞介素6、10含量变化与脓毒症发生及预后的相关性研究

目的 观察重度烧伤患者血清IL-6、IL-10含量的变化,探讨其与脓毒症发生及预后的关系. 方法 选择2007年3月-2011年3月笔者单位收治的160例大面积严重烧伤成年患者,伤后(1.0±6.0)h入院.根据患者脓毒症发生及死亡情况,将其分为非脓毒症组112例、脓毒症存活组36例、脓毒症死亡组12例,后2组患者脓毒症发生时间为伤后(9±5)d,脓毒症死亡组于伤后(18±4)d死亡.另选择20例成年健康志愿者作为健康对照组.分别统计比较4组受试人员的年龄、3组患者烧伤总面积和Ⅲ度烧伤面积.于各例患者入院后(伤后1d)至伤后20 d每日采血分离血清,用ELISA法测定IL-6、IL-10含量;同法采集健康对照组人员血液检测此2项指标.受试者一般资料数据采用单因素方差分析,IL-6、IL-10含量数据采用重复测量资料的方差分析及SNK法(q检验).结果 (1)3组烧伤患者与健康对照组人员年龄接近(F =2.090,P＞0.05),2个脓毒症组患者烧伤总面积明显大于非脓毒症组(q检验P值均小于0.05),脓毒症死亡组烧伤总面积明显大于脓毒症存活组(q检验P ＜0.05).2个脓毒症组Ⅲ度面积明显大于非脓毒症组(q检验P值均小于0.05).(2)3组患者伤后1 ～20 d血清IL-6含量均明显高于健康对照组.伤后1～7d3组患者IL-6含量接近(F值为0.188 ～2.897,P值均大于0.05).伤后第4天起非脓毒症组IL-6含量开始下降;13 d起脓毒症存活组IL-6含量逐渐下降,而同期脓毒症死亡组IL-6含量继续升高.伤后8d起,非脓毒症组IL-6含量[第8天为(262±25) pg/mL]明显低于脓毒症存活组[第8天为(287±38) pg/mL,q检验P＜0.05]和脓毒症死亡组[第8天为(299±22) pg/mL,q检验P＜0.05].伤后13 d起,脓毒症存活组IL-6含量[第13天为(300±33) pg/mL]明显低于脓毒症死亡组[第13天为(338±22) pg/mL,q检验P ＜0.05].(3)3组烧伤患者各时相点IL-10含量均高于健康对照组.伤后1～5d,3组烧伤患者该指标水平接近(F值为1.802 ～2.538,P值均大于0.05);第6天起,非脓毒症组IL-10含量明显低于脓毒症死亡组(q检验P值均小于0.05).伤后第8天,脓毒症存活组IL-10含量为(54±19)pg/mL,显著低于脓毒症死亡组[ (91±23) pg/mL,q检验P＜0.05],根据此结果计算出IL-10含量临界值设为77 pg/mL时,灵敏度(83.33％,10/12)与特异度(91.67％,33/36)之和减1值最大,可用于判断脓毒症结局. 结论 在烧伤患者年龄相近的情况下,脓毒症的发生和结局与烧伤面积、深度有关.血清IL-6、IL-10含量在烧伤脓毒症发病机制中均起重要作用.早期IL-6含量不宜用于判断脓毒症患者预后;早期IL-10含量持续高于77 pg/mL提示患者预后不良.     

血清新喋呤与烧伤病人内毒素血症及脓毒症的关系

为探讨血清新喋呤与大面积烧伤后内毒素血症及脓毒症的关系,对35例烧伤面积大于30%(30%～98%)患者的血清新喋呤、血浆内毒素的变化进行了动态观察。结果表明。烧伤后第3天大多数患者新喋呤升高(P<0.05),但与烧伤面积无显著相关(P>0.05)。严重烧伤第2周以后内毒素血症患者新喋呤水平显著高于无内毒素血症思者(P<0.05～0.01)。同时,伤后第14,21天内毒素血症患者的循环内毒素与新喋呤呈显著正相关(第14天:r=0.368,P<0.05;第21天:r=0.439,P<0.01)。在整个监测期间,脓毒症患者(15例)血清新喋呤水平持续升高,伤后第14,28天与非脓毒症患者相比差异有显著或非常显著意义(P<0.05～0.01)。提示烧伤可引起血清新喋呤升高,但与烧伤面积无关。烧伤后内毒素血症对新喋呤的不断产生可能有显著影响。血清新喋呤的持续升高与严重烧伤后脓毒症的发生与发展密切相关。     

Cause of death and correlation with autopsy findings in burns patients

Objective

Global mortality from burns is decreasing however there is a relative paucity of mortality data in the literature from burns units in the United Kingdom. We present an analysis of burns deaths and correlation with coroners’ autopsy findings from a large regional burns unit.

Design

Retrospective medical note review of patients who died over a 7 year period (January 2005 to April 2011) was undertaken. Patient demographics were recorded in addition to: burn size, depth, length of stay, presence of inhalational injury, organs failing and diagnosis of sepsis. In order to evaluate the accuracy of our pre-mortem clinical diagnosis, we compared post-mortem cause of death with clinical cause of death.

Results

There were 92 deaths out of 4745 admissions for acute burn (crude mortality 1.9%). 37 patients were immediately given comfort care and excluded from analysis. Average age was 52.9 years ± 19.4, average percentage burn 43.7% ± 26.8, and length of stay 26.4 ± 45 days. 80% of deaths were attributable to flame burn (44/55), and 51% (28/55) suffered inhalational injury. Multi-organ failure was the primary cause of death (39/55), with sepsis being the primary trigger (20/39, 51%). Pseudomonas was the most common organism isolated in septic patients. There were significant difficulties in obtaining post-mortem reports and an obvious lack of correlation between coroners’ reports and clinical cause of death.

Conclusions

The principal cause of mortality in our unit was multi-organ failure due to sepsis, which concurs with current literature. Autopsy has previously been shown to be a useful retrospective diagnostic tool, however we challenge its reliability as a result of our study.     

血清新喋呤与烧伤病人内毒素血症及脓毒症的关系

为探讨血清新喋呤与大面积烧伤后内毒素血症及脓毒症的关系，对３５例烧伤面积大于３０％（３０％～９８％）患者的血清新喋呤、血浆内毒素的变化进行了动态观察。结果表明，烧伤后第３天大多数患者新喋呤升高（Ｐ＜０．０５），但与烧伤面积无显著相关（Ｐ＞０．０５）。严重烧伤第２周以后内毒素血症患者新喋呤水平显著高于无内毒素血症患者（Ｐ＜０．０５～０．０１）。同时，伤后第１４，２１天内毒素血症患者的循环内毒素与新喋呤呈显著正相关（第１４天：ｒ＝０．３６８，Ｐ＜０．０５；第２１天：ｒ＝０．４３９，Ｐ＜０．０１）。在整个监测期间，脓毒症患者（１５例）血清新喋呤水平持续升高，伤后第１４，２８天与非脓毒症患者相比差异有显著或非常显著意义（Ｐ＜０．０５～０．０１）。提示烧伤可引起血清新喋呤升高，但与烧伤面积无关。烧伤后内毒素血症对新喋呤的不断产生可能有显著影响。血清新喋呤的持续升高与严重烧伤后脓毒症的发生与发展密切相关。     

重组人生长激素影响重度烧伤患者预后的前瞻性多中心研究

目的观察重组人生长激素(rhGH)对重度烧伤患者预后的影响。方法采用前瞻性多中心随机对照临床试验,将207例成年重度烧伤患者随机分为治疗组(每日皮下注射rhGH)和对照组(同法注射等量等渗盐水),观察两组患者病死率、血糖变化和烧伤脓毒症发生情况。结果治疗组和对照组的病死率分别为0.89%、5.26%(P>0.05),高血糖发生率分别为36.61%、18.95%(以>10.00mmol/L为标准),差异有统计学意义(P<0.01),两组患者脓毒症发生率比较差异无统计学意义(P>0.05).结论适量rhGH在成年重度烧伤患者中应用是安全的,但需注意观察血糖的变化。