严重多发伤患者血浆TNF水平变化的临床意义

目的：探讨严重多发伤患者血浆TNF水平变化的临床意义及其与APACHEⅡ评分的关系。方法：采用酶联免疫分析法测定33例严重多发伤患者及20例健康体检者的血浆TNF水平，同时对33例严重多发伤患者进行APACHEⅡ评分。结果：多发伤患者血浆TNF水平显著高于正常对照组（P＜0．01），多发伤患者中合并多脏器功能障碍综合征（MODS）者血浆TNF水平及APACHEⅡ评分显著高于未合并MODSD者（ 均P＜0．01）；死亡组血浆TNF水平及ARACHEⅡ评分显著高于存活组（均P＜0．01）；ARACHEⅡ评分与血浆TNF水平呈显著正相关（P＜0．05）。结论：严重多发伤患者血浆TNF水平与ARACHEⅡ评分有良好的相关性，测定TNF水平有助于判断预后，对早期诊断MODS可起预警作用。

The clinical significance of tumor necrosis factor levels in patients with severe multiple trauma

Objective To determine the plasma levels of tumor necrosis factor (TNF) in patients with severe multiple trauma and to investigate the relationship between TNF and APACHE II assessment.Methods Plasma TNF levels were measured using enzyme linked immunoadsorbent assay (ELISA) and APACHE II score were also assessed in 33 patients with severe multiple trauma.Results TNF levels of patients with severe multiple trauma were markedly higher than those of controls (P<0.01). TNF levels and APACHE II in MODS (multiple organ defect syndrome) group significantly increased than non-MODS group (P<0.01). TNF levels and APACHE II of non-survivors were significantly higher than those of survivors (P<0.01). Meanwhile TNF levels were closely correlated with APACHE II (P<0.01). Conclusion TNF levels provide early diagnosis for patients with MODS and also provide prognosis for patients with severe multiple trauma.