不同创伤严重程度的多发伤患者血清心肌酶谱指标水平变化及对MODS中心功能障碍的预测价值

目的 探讨不同创伤严重程度的多发伤患者血清心肌酶谱指标［乳酸脱氢酶（lactate dehydrogenase，LDH）、天冬氨酸转氨酶（aspartate aminotransferase，AST）、肌酸激酶同工酶（creatine kinase isoenzyme，CK-MB）、肌酸激酶（creatine kinase，CK）］水平变化及对多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）中心功能障碍的预测价值。 方法 选择多发伤患者67例，根据多发伤患者入院创伤危重评分（injury severity score,ISS）标准将其分为轻度多发伤组（20例）、中度多发伤组（26例）及重度多发伤组（21例）；并根据MODS标准，将其分为MODS组及非MODS组。比较创伤后第1、2、3天重度多发伤组、中度多发伤组及轻度多发伤组LDH、AST、CK-MB、CK水平。比较创伤后第1、2、3天MODS组及非MODS组LDH、AST、CK-MB、CK水平比较。采用Spearman秩相关分析LDH、AST、CK-MB、CK与多发伤患者病情严重程度、多发伤患者合并胸腹部位、多发伤患者伴MODS中的心功能障碍的相关性。分析LDH、AST、CK-MB、CK对多发伤患者伴MODS中的心功能障碍的预测价值。 结果 重度多发伤组APACHEⅡ评分、MODS例数及MODS评分高于中度多发伤组及轻度多发伤组，中度多发伤组APACHEⅡ评分、MODS例数及MODS评分高于轻度多发伤组（P＜0.05）。创伤后第1天、第2天、第3天，重度多发伤组、中度多发伤组、轻度多发伤组LDH、AST、CK-MB、CK水平均呈逐渐降低趋势，重度多发伤组LDH、AST、CK-MB、CK水平均高于中度多发伤组、轻度多发伤组，中度多发伤组LDH、AST、CK-MB、CK水平均高于轻度多发伤组；MODS组和非MODS组LDH、AST、CK-MB、CK水平均呈逐渐降低趋势，MODS组LDH、AST、CK-MB、CK水平均高于非MODS组，组间、时点间、组间·时点间交互作用差异有统计学意义（P＜0.05）。采用 Spearman 秩相关分析结果显示，第1天、第2天、第3天，LDH、AST、CK-MB、CK水平与多发伤患者病情严重程度、多发伤患者合并胸腹部位呈正相关、多发伤患者伴MODS中的心功能障碍均呈正相关（P＜0.05）。第1天，多发伤患者伴MODS中的心功能障碍ROC曲线显示，LDH、AST、CK-MB、CK对多发伤患者伴MODS中的心功能障碍有预测价值（P＜0.05）。 结论 血清心肌酶谱指标水平随多发伤患者病情加重而升高，其与多发伤患者创伤严重程度、胸腹部位及发生MODS中的心功能障碍呈正相关，且是多发伤患者发生MODS中的心功能障碍的危险因素。

Changes of serum myocardial zymogram level in patients with multiple injuries of different severity and their predictive value for cardiac dysfunction in MODS

Objective To investigate the changes in serum myocardial zymogram indexes ［lactate dehydrogenase (LDH) and aspartate aminotransferase (AST), creatine kinase isoenzyme (CK-MB), creatine kinase (CK)］ of patients with multiple injuries of different severity and their predictive value for cardiac dysfunction in multiple organ dysfunction syndrome (MODS).Methods A total of 67 patients with multiple injuries were selected as the research subjects. According to the injury severity score (ISS) criteria, patients with multiple injuries were divided into mild multiple injury group (n=20), moderate multiple injury group (n=26) and severe multiple injury group (n=21). According to the MODS standard, they were divided into MODS group and non-MODS group. The LDH,AST,CK-MB and CK levels of severe multiple injury group, moderate multiple injury group and mild multiple injury group were compared on the 1st, 2nd and 3rds day after injury. The LDH, AST, CK-MB and CK levels were compared between MODS group and non-MODS group on the 1st, 2nd, and 3rd days after injury. Spearman rank correlation was used to analyze the correlation of LDH, AST, CK-MB and CK levels with disease severity, combined chest and abdominal sites in patients with multiple injuries, and cardiac dysfunction in patients with multiple injuries and MODS. The predictive value of LDH, AST, CK-MB and CK levels in cardiac dysfunction in patients with multiple injuries with MODS was analyzed.Results APACHEⅡ score, number of MODS and MODS score in severe multiple injury group were higher than those in moderate multiple injury group and mild multiple injury group, while APACHEⅡ score, number of MODS and MODS score in moderate multiple injury group were higher than those in mild multiple injury group (P＜0.05). The levels of LDH, AST, CK-MB and CK in severe multiple injury group, moderate multiple injury group and mild multiple injury group all showed a decreasing trend on the 1st, 2nd and 3rd days after injury, while the levels of LDH, AST, CK-MB and CK in severe multiple injury group were higher than those in moderate multiple injury group and mild multiple injury group. The levels of LDH, AST, CK-MB and CK in moderate multiple injury group were higher than those in mild multiple injury group. The levels of LDH, AST, CK-MB and CK in MODS group and non-MODS group showed a gradually decreasing trend, and the levels of LDH, AST, CK-MB and CK in MODS group were higher than those in non-MODS group; The difference of interaction between groups, time points and time points between groups were statistically significant (P＜0.05). Spearman rank correlation analysis showed that on the 1st, 2nd and 3rd days after injury, LDH, AST, CK-MB and CK levels were positively correlated with the severity of disease and combined chest and abdominal sites in patients with multiple injuries, and with cardiac dysfunction in patients with multiple injuries and MODS (P＜0.05). On the 1st day, receiver operating characteristic (ROC) curve showed that LDH, AST, CK-MB and CK had predictive value for cardiac dysfunction in patients with multiple injuries and MODS (P＜0.05).Conclusion The levels of serum myocardial zymogram increase with the aggravation of patients with multiple injuries, which are positively correlated with the severity of patients with multiple injuries, combined chest and abdominal sites and the cardiac dysfunction in the occurrence of MODS, and are also risk factors for the cardiac dysfunction in the occurrence of MODS in patients with multiple injuries.