大面积烧伤患者血清透明质酸浓度检测的临床意义

目的 :探讨大面积烧伤患者血清透明质酸 (HA)浓度变化与肝细胞损伤的关系。方法 :采用放射免疫和酶联免疫吸附等技术 ,比较分析烧伤严重程度不同及其并发全身炎症反应综合征 (SIRS)、多脏器功能障碍综合征 (MODS)、多器官衰竭 (MOF)和死亡患者各组血清 HA、肿瘤坏死因子α(TNFα)和临床常规肝肾功能指标。结果 :烧伤后 2周内血清 HA浓度一直维持高水平 ,并随烧伤严重程度增加和 SIRS、MODS的产生 ,其数值逐步升高、相差显著 (P<0 .0 0 1 ) ,但在 MODS向 MOF发展直至死亡前后 ,血清 HA值又由高限急剧降低。直线相关分析显示 ,血清 HA浓度变化与烧伤严重程度和 SIRS等并发症的发生发展密切相关 (P<0 .0 1 ) ,与血清 TNFα和天冬氨酸转氨酶、总胆红素值呈正相关 (P<0 .0 5或 P<0 .0 1 ) ,而与血浆白蛋白、白蛋白 /球蛋白比值呈负相关 (P均 <0 .0 5 )。结论 :血清 HA浓度中、重度升高可能与 TNFα等持续损伤肝内皮细胞功能有关 ,可将其作为临床大面积烧伤患者肝损伤、病情严重程度和预后判断的敏感指标

Clinical significance of detection of serum hyaluronic acid concentration in severe burn patients

OBJECTIVE: To study the relationship between the changes in serum hyaluronic acid (HA) concentrations and injury of hepatocytes in severe burn patients. METHODS: Radioimmunoassay and enzyme-linked immunosorbent assay (ELISA) were used to detect HA and tumor necrosis factor-alpha(TNF-alpha) concentrations in serum, and biochemical indexes for hepatic function and renal function in burn patients that were divided into different groups: systemic inflammatory response syndrome(SIRS), multiple organ dysfunction syndrome(MODS). Multiple organ failure(MOF) and non-surviving patient groups. RESULTS: In two weeks after burns, the serum HA concentration attained a high level. With the increase of severity of disease, the values of the serum HA concentration were elevated progressively (P<0.001). At the onset of MOF till death, the serum HA content was rapidly decreased. Lineal correlation analysis indicated that the change in the serum HA concentration was closely correlated with SIRS, burn sepsis, MODS and death (P<0.01). It was positively correlated with TNF-alpha, aspartate aminotransferase (AST) and total bilirubin (P<0.05 or P<0.01), and negatively correlated with plasma albumin and albumin/globulin(both P<0.05). CONCLUSION: The increment in serum HA levels is relate with the impairment of the hepatic endothelial cells due to TNF-alpha etc. The HA content in serum can be used as a sensitive indicator for judging injury of liver, seriousness of the injury, and prognosis of the patient.