【摘要】 目的 分析腹部创伤后并发脓毒症患者血浆中可溶性血栓调节蛋白（TM）水平变化，分析其与疾病严重程度以及28d病死率的相关性。方法 选取在2019年3月—2021年10月期间新疆医科大学第一附属医院重症医学科收治确诊的腹部创伤后并发脓毒症患者59例作为脓毒症组进行回顾性研究，男性27例，女性32例；年龄17～75岁，平均51.2岁；致伤原因：道路交通伤20例，高处坠落伤17例，摔伤18例，重物砸伤4例。选择同期来笔者医院就诊的腹部创伤非脓毒症患者50例作为非脓毒症组，其中男性26例，女性24例；年龄14～72岁，平均52.6岁；致伤原因：道路交通伤23例，高处坠落伤15例，摔伤11例，重物砸伤1例。比较两组在入科后即刻、12h、48h的可溶性TM水平，并对其动态情况进行观察，同时记录两组患者入科后即刻、12h、48h的炎症指标[髓系细胞触发受体-1(TREM-1)、前降钙素（PCT）、C反应蛋白（CRP）、高迁移率族蛋白-1(HMGB-1)]以及28d的病死率，采用Pearson分析血浆TM与TREM-1、PCT、CRP、HMGB-1水平的相关性。同时按照腹部创伤后并发脓毒症患者在28d的病死率分为存活组（n=24）与死亡组（n=35），对比两组患者入科后即刻、12h、48h的TM水平。结果 整体分析可见，两组间比较、时间点比较及交互作用差异均有统计学意义（P<0.05）。进一步两两比较，组内比较显示：与入科后即刻相比，两组在入科后12h、48h的TM、TREM-1、PCT、CRP、HMGB-1均明显升高（P<0.05）。组间比较显示，两组相比入科后即刻、12h、48h的血浆TM、TREM-1、PCT、CRP、HMGB-1水平均较高，差异有统计学意义（P<0.05）。采用Pearson分析可见，腹部创伤后并发脓毒症患者入科后即刻、12h、48h的血浆TM分别与TREM-1、PCT、CRP、HMGB-1水平呈现出正相关性（P<0.05）。行整体分析以及进一步两两比较，存活组与死亡组患者在入科后24h、48h内的血浆TM值相比，差异均无统计学意义（P> 0.05）。结论 腹部创伤后并发脓毒症患者在入科后早期则可观察到TM水平的升高，且与机体炎症反应的程度具有密切的正相关性，不过在评估患者预后方面未表现出明显的差异，需要进一步的证实及研究。更多还原

【Abstract】 Objective To explore and analyze the level of soluble thrombomodulin(TM) in plasma in patients with sepsis after abdominal trauma,and to analyze its correlation with disease severity and 28-day mortality.Methods From Mar. 2019 to Oct. 2021,59 patients with post-abdominal trauma complicated by sepsis who were admitted and diagnosed in the Department of Critical Care Medicine of The First Affiliated Hospital of Xinjiang Medical University were selected as the observation group for prospective study. There were 27 males and 32 females,their age ranged from 17 to 75 years,with an average age of 51. 2 years. Injury factors included: 20 cases of road traffic injuries,17 cases of falling from heights,18 cases of falling injuries,and 4 cases of heavy object smashing injuries. Fifty patients of abdominal trauma with non-sepsis were selected as the control group,including 26 males and24 females. Their age ranged from 14-72 years,with an average age of 52. 6 years. The injury factors included:23cases of road traffic injury,15 cases of falling from height,11 cases of fall injury,and 1 case of heavy object smashing injury. The soluble TM at admission,12 hours,and 48 hours after admission were compared and dynamically observed. Indicators such as myeloid cell trigger receptor-1( TREM-1), precalcitonin( PCT), C-reactive protein(CRP),high mobility group box-1(HMGB-1) and 28-day mortality at above time points were also recorded. The correlation between plasma TM and the levels of TREM-1,PCT,CRP,and HMGB-1 was analyzed by Pearson. At the same time,patients with abdominal trauma combined with sepsis were divided into a survival group(n= 24) and a death group(n= 35) according to the 28-day mortality rate. The TM levels of the two groups were compared immediately after admission,12 hours,and 48 hours after admission.Results The overall analysis showed that there were statistically significant differences between the two groups in comparison,time point comparison and interaction(P<0. 05). Further pairwise comparisons and intra-group comparisons showed that compared with immediately after admission,the TM,TREM-1,PCT,CRP,and HMGB-1 of the two groups were significantly increased at the 12th and48th hours after admission,and the differences were statistically significant(P< 0. 05). The comparison between groups showed that the plasma levels of TM,TREM-1,PCT,CRP,and HMGB-1 in the observation group were higher than those in the control group immediately after admission,12 hours,and 48 hours after admission,and the differences were statistically significant(P< 0. 05). Pearson analysis showed that the plasma TM of patients with post-abdominal trauma complicated by sepsis was positively correlated with the levels of TREM-1,PCT,CRP,and HMGB-1immediately after admission,12 hours,and 48 hours after admission(P< 0. 05). Overall analysis and further pairwise comparisons showed that there was no significant difference in plasma TM values between the survival group and the death group within 12 hours,and 48 hours after admission(P> 0. 05).Conclusion In patients with post-abdominal trauma complicated by sepsis,the increase of TM level can be observed in the early stage after admission,and it has a close positive correlation with the degree of the body’s inflammatory response. The difference in prediction of outcome requires further confirmation and research.更多还原