Vascular Endothelial Growth Factor And Their Soluble Receptors With Prognostic Significance Early After Trauma

Objective: With the rapid development of transportation and urbanconstruction, natural disasters occurred frequently, increasing the incidence oftrauma patients, with a high mortality rate. According to statistics, trauma andpoisoning had become the fourth largest cause of death in China. Among them,the scene of death and early death are mainly due to bleeding and seriousdamage of important organs. The late death is mainly due to traumatic shockand multiple organ failure and so on. Traumatic inflammatory response playsan important role in the occurrence of traumatic shock and the development ofmultiple organ failure. Endothelial activation and dysfunction is the centralpart of the traumatic inflammatory response. And vascular endothelial growthfactor (VEGF) and its soluble receptors play an important role in theendothelial activation and dysfunction. This paper mainly discusses the serumlevel of VEGF and its soluble receptors early after trauma, and to determinetheir clinical significance.Methods:60patients of multiple trauma in the third affiliated hospital ofhebei medical university emergency departments were enrolled. When thepatients coming the hospital, blood immediately, and send the blood gasanalysis. Record the base excess(BE)values in the blood gas analysis.Evaluted the patients’ basic situation, and recorded injury severity score (ISS)with patients. And through the ISS score divided the patients into ISS <16,25,ISS ISS16->25three groups. At the same time took venous blood about3ml,injected in vitro containing separation gel. Let the blood stand at room about20minutes, then centrifuged it for20minutes (3000RPM).Collectedsupernatant carefully, repackaging into3eppendorf (EP) tube, and each EPtube contained about100ul supernatant. Then freezed them at-80℃forstandby. Specimen collection, filled with VEGF, soluble vascular endothelial growth factor receptor1(sVEGFR1), soluble vascular endothelial growthfactor receptor2(sVEGFR2) enzyme-linked immuno sorbent assay (ELISA)kit, respectively, and measured its concentration. And monitoring of patientswith late acute respiratory distress syndrome (ARDS) and28-day mortality.The2012Berlin standard for diagnosing ARDS. According to whether ARDSis divided into ARDS group and non ARDS, and divided into death andsurvival groups according to whether the death.Results:1The relationship of serum VEGF, sVEGFR1, sVEGFR2and ISS scoreearly after trauma.(1)There are significant different among control group, ISSscore <16group, ISS score16-25group and ISS score>25group in serumVEGF（P＜0.05）. However, comparing between the inner group, there are nosignificant different among control group and ISS score <16group, ISS score16-25group（P＞0.05）.And there are no significant different between ISSscore <16group and ISS score16-25group（P＞0.05）. The serum VEGFlevel in ISS score>25group was lower than control group, ISS score <16group and ISS score16-25group（P<0.05）（.2）There are significant differentamong control group, ISS score <16group, ISS score16-25group and ISSscore>25group in serum sVEGFR1（P＜0.05）. Comparing between theinner group, ISS score <16group, ISS score16-25group and ISS score>25group were higher than control group（P＜0.05）. ISS score16-25group washigher than ISS score <16group（P＜0.05）. ISS score>25group were higherthan ISS score <16group and ISS score16-25group（P＜0.05）.(3) There aresignificant different among control group, ISS score <16group, ISS score16-25group and ISS score>25group in serum sVEGFR2（P＜0.05）.Comparing between the inner group, ISS score <16group, ISS score16-25group and ISS score>25group were lower than control group（P＜0.05）. ISSscore16-25group was lower than ISS score <16group（P＜0.05）. ISSscore>25group were lower than ISS score <16group and ISS score16-25group（P＜0.05）.The linear regression analysis between the serum VEGF and its receptors concentration with60cases of multiple trauma patients and the ISS score:There is no significant correlation between the level of VEGF and ISS score.There is positive significant correlation between the level of sVEGFR1andISS score（β＞0）. There is negative significant correlation between the levelof sVEGFR2and ISS score（β＜0）.2The relationship of serum VEGF, sVEGFR1, sVEGFR2and baseexcess early after trauma. The linear regression analysis between the serumVEGF and its receptors concentration and base excess: There is no significantcorrelation between the level of VEGF and base excess. There is positivesignificant correlation between the level of sVEGFR1and base excess（β＞0）. There is negative significant correlation between the level of sVEGFR2and base excess（β＜0）.3The relationship of serum VEGF, sVEGFR1, sVEGFR2betweennon-ARDS group and ARDS group early after trauma. There is no significantdifferent between non-ARDS group and ARDS group in serum VEGF（P>0.05）.The level of sVEGFR1was higher in ARDS group thannon-ARDS group（P<0.05）. The level of sVEGFR2was lower in ARDSgroup than non-ARDS group（P<0.05）.4The relationship of serum VEGF, sVEGFR1, sVEGFR2betweensurvival group and death group after trauma. There is no significant differentbetween survival group and death group in serum VEGF（P>0.05）.The levelof sVEGFR1was higher in death group than survival group（P<0.05）.Thelevel of sVEGFR2was lower in death group than survival group（P<0.05）.Conclusion:1There are no significant correlation among the level of VEGF，traumatic severity and post-traumatic hypoperfusion. There is positivesignificant correlation among the level of sVEGFR1and traumatic severityand post-traumatic hypoperfusion. There is negative significant correlationbetween the level of sVEGFR2and traumatic severity and post-traumatichypoperfusion. sVEGFR1, sVEGFR2may become the important predictors intrauma severity, the prognosis of patients and the post-traumatic low perfusion.2The increases of sVEGFR1and the reduce of sVEGFR2after traumamay be closely associated with the occurrence of late ARDS. The relationshipof VEGF signaling system and of ARDS studies confirm still need more test.