| ObjectiveTo research the regularity of dynamic change on serum cholinesterase activity in severely burned patients,in order to analyze the correlation between serum cholinesterase and the severity of burn,prognosis,biochemical index(albumin,alanine aminotransferase,creatinine,hemoglobin),to explore the change,clinical significance and possible mechanism of these indicators after injury,It provides a reference for the judgment of the condition,the prognosis and the treatment of the patients.Methods267 cases of severely burned patients with TBSA?30% from the First Affiliated Hospital of PLA General Hospital was collected from January 2014 to December 2016,and they are compared with 30 cases of healthy subjects as control group retrospectively.The patients with total burn area was divided into30%~49% TBSA group(127 cases),50%~79% group TBSA(79 cases),more than 80% TBSA group(61 cases),and serum ChE data of patients and healthy subjects were collected at 1,3,5,7,9,11,14,21,28,35,42 days after extraction,the activity of serum ChE were compared the case group and control group,and the difference of serum Ch E activity(the lowest value at 21 d after injury)in 21 d cases was compared,and the correlation between burn area and ChE activity at different time points was analyzed.According to theprognosis,267 burn patients were divided into survival group(232 cases)and death group(35 cases).The serum ChE activity at each time point and the difference of the 21 d,28d activity(21d,28 d to the lower value)was compared between two groups at different time points.In addition,the data of serum albumin(ALB),alanine aminotransferase(ALT),creatinine(Cr)and hemoglobin(HB)were extracted and analyzed after injury at each time point.The correlation between serum ChE and the above indicators was analyzed.Then ALB,ALT,Cr and HB were analyzed by stepwise linear regression,screening the index related to serum ChE significantly at each time point after the injury.The dynamic changes of ALB,ALT,Cr and HB after injury were further observed and analyzed,and the differences between the four indexes were compared between the two groups of survival and death.Logistic regression analysis was used to screen out independent risk factors for predicting the prognosis of large area burns in the serum ChE and other indicators at each time point,to determine a sensitive indicator of prognosis,and draw the injury at each time point after judgment subjects prognosis operating characteristic curve(ROC curve),to determine the best time critical value,sensitivity,specificity,Jorden index and the area under the ROC curve,and to compare with the area under the ROC curve of the serum ChE at the corresponding time point.ResultsIn addition to 1d after injury,the activity of serum ChE in all the other time points from case group was lower than that of the control group(8.18±1.15kU/L),and the difference was statistically significant(P<0.01).At 21 d,28d after injury,serum ChE activity of 30%~49% TBSA group was significantly greater than that of 50%~79% TBSA group and more than 80% TBSA group,and serum ChE activity of the 50%~79% TBSA group was significantly higher than that of more than 80% TBSA group,the difference was statistically significant(P<0.05),but at the other time point serum ChE activity of the different group showed thatthere were no statistically significant difference.Pearson correlation analysis showed that there was a significant positive correlation between serum ChE activity and burn area at the 3,5,7 day after injury(P<0.01),while there was a significant negative correlation at 14,21,28 d after injury(P<0.05,P<0.01),There was no significant correlation between the at rest time points(P>0.05).At21 d after injury,30%~49%TBSA group of serum ChE decreased(1.18±1.70kU/L)less than 50%~79% in group TBSA(2.20±2.01kU/L)and ?80%TBSA group(3.35±1.89kU/L),and the decrease of 50%~79% TBSA group was less than ?80% TBSA group,and the difference was statistically significant(P<0.05).The serum ChE activity decreased to the lowest value(4.89±1.48kU/L)at 21 d after injury in the survival group,and the 28 d decreased to the lowest value(4.21±1.37kU/L)in the death group.At 28 d after injury,the activity of serum ChE in the survival group(4.92±1.46kU/L)was significantly higher than that in the death group(4.21±1.37kU/L),and the difference was significant(P<0.05).On the twenty-first,twenty-eighth day after injury,the serum ChE activity in the survival group decreased(2.26±1.93,2.43±1.87kU/L),which was significantly lower than that in the death group(3.61±2.20,4.22±1.94kU/L),respectively,and the difference was significant(P<0.05).For each time point of serum ChE activity and other indicators of the Pearson correlation analysis showed that in addition to 35 d after injury,the serum ChE were positively correlated with ALB(P<0.05);ChE and ALT at 14 d days after injury were positively correlated(P<0.05),the other point was not related(P>0.05);at 7d and 42 d after injury,serum Ch E was positively correlated with Cr(P<0.05),the other point was not related(P>0.05);at 1,3 and 21 d after injury,serum ChE was positively correlated with Hb(P<0.01),they were not related at the other point(P>0.05).By stepwise linear regression analysis at each time point,we screened related significantly indicators with serum Ch E in patients with large area burns.At 1d and 3d after injury serum ChE wassignificantly related to the index of HB and ALB;At 5,9,21,28 d and 42 d after injury,serum ChE was significantly related to the index of ALB;At 7d after injury,serum ChE was significantly related to the index of ALB and Cr;At 14 d after injury,serum ChE was significantly related to the index of ALB and ALT;At 35 d after injury,there was no index significantly correlated with serum ChE.The serum ALB was decreased and then increased after injury,and it was relatively stable 11 days after injury,and the change was small.Serum ALT increased gradually after injury,and reached the highest level on the 7 day after injury,then decreased.It still had a downward trend after 35 days,and decreased to the lowest value at 42 day after injury.Serum Cr did not change significantly within 3 days after injury.3~5 days after injury were in a state of decline,but 5~21 days after injury were relatively stable,and 21~28 days decreased rapidly after injury,and 35 days later,they were relatively stable.Serum HB decreased rapidly in 1~5 days after injury,and decreased slowly after5~21 days after injury,and was relatively stable after 21 days after injury.The differences of ALB,ALT,Cr and Hb in different prognosis groups were compared.1 days after injury,the survival of serum ALB(32.45±7.04g/L)was significantly higher than that of death group(23.61±8.75g/L),there was significant difference(P<0.05),and 5,21 and 35 day after injury,ALB of survival group(31.85±4.71,32.60±5.21,32.48±5.65g/L)was significantly lower than the death group(34.59±6.11,37.10±8.62,36.99±6.43g/L),there were significant differences(P<0.05),and there was no significant difference at other time points difference between the two groups of serum ALB(P>0.05).At 11,14 and 21 day,serum ALT of survival group(77.07±73.94,74.67±74.69,65.59±53.09u/l)was significantly higher than that of death group(42.68±42.18,42.20±23.66,38.71±27.93u/l),there was significant difference(P<0.05),there was no significant difference in serum ALT between the two groups at the rest of the time points(P>0.05).There was no significant difference in serum Cr betweenthe survival group and the death group except for 3 and 35 days after injury(P>0.05).The death groups at other time points were significantly higher than those in the survival group,and the difference was significant(P<0.05).On the 9day after injury,the serum HB(114.34±18.10g/L)in the survival group was higher than that in the death group(106.60±16.76g/L),and the difference was significant(P<0.05).There was no significant difference in serum HB between the two groups at any other time points(P>0.05).Serum ChE and other indexes,ALB,ALT,Cr and HB were the independent variables,and the results of Logistic regression analysis were found.The results were found that 1 days after injury,serum ChE(OR=1.814)and Cr(OR=1.024)is an independent risk factor for prognosis;3 days after injury,serum ChE(OR=1.809)is the independent risk factors of prognosis;5 days after injury,ALB(OR=1.098)and Cr(OR=1.020)is an independent risk factor for prognosis;7days after injury,Cr(OR=1.019)is an independent risk factor for prognosis;9days after injury,Cr(OR=1.038)is the independent risk factor for prognosis;11days after injury,Cr(OR=1.057)is an independent risk factor for prognosis;14days after injury,Cr(OR=1.043)is an independent risk factor for prognosis;21days after injury,Cr(OR=1.043)is an independent risk factor for prognosis;28days after injury,Cr(OR=1.045)is the prognosis independent risk factor for prognosis;35 days after injury,ALB(OR=1.441)and Cr(OR=1.059)were independent risk factors to judge the prognosis,and the five indexes could not judge the prognosis on the 42 day after injury.Therefore,for patients with extensive burn,serum Cr and Ch E are an independent risk factor for judging prognosis.The ROC curves of Cr and Ch E at each time point were drawn and the area under the two curves was compared.The area under the curves at 1,3,and 5 days after injury of serum ChE was larger,and on the 3 and 5 days after injury the area under the curve wassignificantly higher than 0.5(P<0.05).The area under the curves of Cr at all time points was significantly greater than 0.5(P<0.05),and the area under the curve of Cr was larger at 11,21 and 42 days after injury.The area under the curve of serum Cr was significantly larger than the area under the curve of cholinesterase(P<0.05)at 9,11,14,21 and 28 days after injury,and the cut off value of Cr were 84.20umol/L,68.35umol/L,77.40umol/L,62.15umol/L,42.85umol/L respectively,and at other point Cr and ChE could be combined to predict the prognosis of patients.ConclusionsAfter burn,the activity of serum ChE decreased significantly,and there was a tendency to decrease and then increase,and the lowest value of 21 d after injury.The area of burn was negatively correlated with the activity of serum ChE,and at 14,21 and 28 d after injury the correlation was higher.And the greater the decrease of serum ChE activity,the worser the prognosis of the patients.The relationship between serum ChE and ALB was the highest.The levels of ALB,Hb and Cr in the burn patients were decreased,while the level of ALT was increased.The death group of serum Cr at all time points was higher than of that in the survival group,so the level of Cr could be used to predict the outcome of the patients.The Cr value of serum is also an indicator of prognosis,and the higher the serum Cr level,the worse the prognosis of the patients.Therefore,serum ChE and Cr have a certain value in reflecting the severity of the burn and predicting the prognosis of the patients. |
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