Study On The Correlation And Clinical Significance Between The Expression Of Inflammatory Factors And Classification Of TTS On Patients With Chest Trauma

Objective:Though observing the expression serum cytokines in acute stage of patients with chest trauma, including the dynamic change of tumor necrosis factor alpha(TNF-α)and high sensitive C-reactive protein(Hs-CRP),meanwhile, the TTS score are introduced for the purpose of making a classification of patients with chest trauma to analyze the severity of illness. This paper study on the relationship between the expression of inflammatory factors and classification of TTS for patients with thoracic trauma, and investigate its role in the early prediction and the assessment of clinical prognosis of patients. It provides new ideas for us to the judgment and treatment of the severity of chest. Method:The source of case group: selects 43 cases of hospitalized patients with chest trauma treatment from January 2014 to January 2015 in Department of thoracic surgery of our hospital, including male 22 cases, female 21 cases. The range of age is 39.3士8.6. According to the chest trauma severity score(TTS score) to make a classification. Inclusion criteria: 1. injured were hospitalized within 24 hours; 2. comply with the diagnostic criteria of chest trauma according to the medical history and imaging checks; 3. hospital stay for full 7 days. Exclusion criteria: 1. recently suffering from various acute and chronic infections; 2. have the surgery history before admission within 2 months; 3 if combined with other diseases, would lead to a high level of serum inflammatory cytokines; 4 data collection is not complete.The source of control group: selects healthy volunteers in 20 cases in the corresponding period, including male 11 cases, female 9 cases. The range of age is 39.3士8.6. The control group in age, gender are matched with the case group, the difference was not significant statistically(P>0.05).Firstly, contains the detailed record of case patients for the study object,monitoring by CT imaging, biochemical examination of the vital signs and related blood, collection of venous blood on the onset of the first day, third day, and seventh day, and the detection of Hs-CRP index. Secondly, after separating serum according to the relevant requirements of preservation, the unified ELISA method was used to detect the dynamic changes of TNF- alpha index. Thirdly, the control group in the study needs a collection of venous blood to measuring the serum cytokines: TNF- alpha, Hs-CR for comparison and reference.Statistical methods: using SAS9.3 statistical software data processing data, data are expressed in mean 士standard deviation and the median, after testing its normal distribution by the measurement data, with rank sum test and independent t test, count data using chi-square test, correlation analysis by using Pearson rank correlation method. Results:1.The case group was subdivided into two groups according to the chest injury severity score(TTS score), TTS score of cases in 16-25 points were called group A(n = 22); and 5-15 points cases were called group B(n = 21). Patients in group A, their TNF-αcontent in the serum showed dynamic changes, after the onset of the disease, TNF-αcontent in serum are increased, would reach the peak on the third day and decline seventh day. Each period of the TNF-αcontents in serum were higher than the normal control group, there were significant statistical differences(P<0.05). But the TNF-αcontents in serum compared in group B compared with the control group, there were no significantly statistical difference(P>0.05).2.The serum TNF-αcontent of patients in group A of the case group was measured in 3 time nodes(d1,3,7 days),with the comparison of Group B in the case group,there was a statistical difference(P<0.05); and the samples of Hs-CRP content of patients in group A of the case group was measured in 2 time nodes(d1,3days),with the comparison of Group B in the case group,there was a statistical difference(P<0.05)3.In group A and group B of the case group, the Hs-CRP content of patients showed dynamic changes, after the onset of the disease, TNF-αcontent in serum are increased, would reach the peak on the third day and decline seventh day.The Hs-CRP content were higher than the normal control group in each period, there was a difference(P<0.05).4.In the case group, The first day TNF-α level of patients in group A were carried on a correlation analysis with TTS scores, there was a significantly positive correlation; The first day TNF-α level of patients were carried on a correlation analysis with the seventh day TNF-α level; the Hs-CRP levels of patient in group A in each period were carried on a correlation analysis in pairs, there was a significantly positive correlation. The seventh day TNF-αlevel of patients in group A were carried on a correlation analysis with TTS scores, there was a significantly positive correlation;5.Three single factors were found by the statistical analysis(including 1.TTS scores 2. the serum TNF- level within 24 hours of onset; 3.serum TNFlevels in the third day) have predictive value on thoracic trauma patients occurred MODS.6. Statistics show that: TTS scores combined with serum TNF-αlevels 72 h the highest predictive value on thoracic trauma patients occurred MODS.(AUC=0.9091) Conclusion:1.The study shows that the content of TNF-αand Hs-CRP index in patients with severe chest trauma are not only increased, but also show a dynamic change, this suggest that the cytokines involve in the pathophysiological occurred in process of chest trauma, and provides a reference for the prediction of patients with adverse prognosis.2. The prediction value of patients occurring MODS can be improved significantly by the analysis of TTS scores combined with serum TNF-αlevels3. The degree of chest trauma can be judged by the TTS scores.