| Objective:Analysis of epidemiological characieristics and clinical features of severe chest trauma in different periods,To investigate risk factors affecting the mortality in SCT,to make further improvement of severe chest trauma care outcome.To investigate the polymorphisms of CD14 gene promoters,and to explore whether such polymorphisms are associated with the susceptibility to multiple organ dysfunction syndrome(MODS) in Chongqing population,which is hope to provide a new thought of the clinical therapy of severe chest trauma.Methods:1. The clinical data of severe chest trauma from Chongqing Emergency Medical Center,The First Affiliated Hospital,Chongqing medical University and Daping Hospital,Third Military Medical University were collected.2. The all data of the patients from Chongqing Emergency Medical Center from January 1990 to December 2009 divided into two periods(Cases treated before 2000 and those after 2000,survival group and death group).Stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting mortality.3. Using polymerase chain reaction-restriction fragment length polymorphism method,the authors detected the single nucleotide polymorphisms of the promoter region of CD14 gene at position -1145 and -159 in 106 severe chest trauma patients (47 with MODS).Results:1.Before and after 2000, the morbidity rate of blunt trauma and sharp instrument injury,have statistical significances(P<0.01,P<0.05). After 2000,the pre-hospital time and transfers ratio have statistical significances(P<0.01,P<0.05). Before and after 2000,there were statistical significances in thoracic AIS and RTS(P<0.01).After 2000, the therapeutic effect of pulmonary infection and hemorrhagic shock has significantly improved(P=0.019,P=0.008),The leading cause of death was hypovolemic shock(59.41%),fllowed by other reasons, ARDS/respiratory failure(18.81%),MODS(13.86%),primary brain trauma(7.92%),the two groups was no statistical significance.There were statistically difference of trauma score in the death group and the survival group(P<0.01).2.The factors affecting mortality in the SCT,included: age (X1,B= -0.035,OR=0.962,P=0.01),hemorrhagic shock(X6,B=1.710,OR=1.291,P= 0.001),multiple organ dysfunction syndrome(X7,B=3.453,OR=1.028,P< 0.001),Pulmonary infection(X9,B=2.396,OR=10.941,P<0.001),abdominal organ injury (X11,B=1.542,OR=1.210,P=0.005),GCS(X13,B=0.485,OR= 1.624,P=0.014),thorax AIS(X14,B=0.487,OR=1.622,P<0.001).3.The polymorphisms of CD14 gene promoters are associated with the susceptibility to multiple organ dysfunction syndrome (MODS) in Chongqing population.1.Trauma patients carrying G allele appeared to have higher risk of MODS comparing to those carrying A allele at position-1145(P=0.033).The MODS scores in trauma patients carrying G allele were significantly higher than those carrying A allele(P=0.217 for dominant efect, and P=0.037 for recessive efect).2.The MODS scores in trauma patients carrying T allele were significantly higher than those carrying C allele at position -159(P=0.048 for dominant efect, and P=0.198 for recessive efect).3.Compare to only one point mutation,two points simultaneous mutation have higher risk of MODS(P<0.01), however there was no difference in MODS scores (P=0.239).Conclusion:1.After 2000, the number of Severe chest trauma(SCT) was significantly increased,more serious, prevention and treatment of serious complications ,to further improve the treatment program are effective way to a successful outcome.2.Age, complications (hemorrhagic shock, MODS, pulmonary infection )were independent risk factors to estimate the trauma outcome. To development effective treatment programs for these risk factors plays the key role for reduce mortality of patients with severe chest trauma.3.The polymorhisms of CD14 gene promoters is associated with MODS after severe chest trauma in Chongqing population,which is hope to provide a new thought of the clinical therapy of severe chest trauma.
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