| Objective:craniocerebral injury combined with multiple trauma have high mortality and disability.It’s critical to determine the severity and prognosis of multiple trauma to the patient’s therapeutic effect and the duration of recovery.There are no clear and effective laboratory objective indicators to evaluate injuries and prognosis.The soluble tumor necrosis factor receptor 1 reflect the degree of injury to a certain extent.It’s a single chain glycoprotein fragment,which is formed by protease and tumor necrosis factor receptor lysis and abscission due to various causes of trauma or inflammation.This study is to explor the correlation,which is between the changes in the level of serum s TNFR1 and the severity of the diease and the prognosis of the craniocerebral injury combined with multiple trauma.Methods:50 hospitalized patients with craniocerebral injury combined with multiple trauma who had been diagnosed by injury mechanism and imaging examination were selected in the experimental group between June 2017 and February 2018 in the emergency center of our hospital.8 cases in the control group were randomly selected for physical examination in the medical center of our hospital.Samples of pregnancy,diabetes,cardiovascular disease,immunodeficiency were eliminated by the experimental group and the control group.The patients with craniocerebral injury combined with multiple trauma were divided into two groups according to the severity score of injury:the light and medium group(ISS≤16 n=32)and the heavy group(ISS>16 n=18).The hospitalized patients were divided into the mild dependence group(>61 分,n=32),the poisoning dependencegroup(41-60 分,n=11)and the severe dependence group(≤40 分,n=7)based on the daily living ability assessment scale when they were discharged from hospital.The serum of first,fourth and seventh days in the experimental group and the 1ml of the serum in the first day of the control group were collected.All specimens are placed at-80℃ fridge for preparation.Determination of serum s TNFR1 content by enzyme linked immunosorbent assay.The date were processed with repeated meaurement of variance to explain the correlation between serum s TNFR1 levels and the severity and prognosis of craniocerebral injury combined with multiple trauma.Results:(1)In the control group,the serum s TNFR1 level was 55.066±8.392pg/ml.The minimum value of s TNFR1 in the patients with craniocerebral injury combined with multiple trauma was 261.57pg/ml,and the maximum was up to 2661.29pg/ml.(2)The results of the comparison of serum s TNFR1 levels in multiple injuries at the same time point:It was significant that the serum s TNFR1 level in the multiple trauma group was higher than that in the light medium group at first,fourth,seventh days(P<0.001).The results of the comparison of serum s TNFR1 levels in the experimental group and the control group with the time change:The level of serum s TNFR1 in the control group was relatively constant.The dynamic changes of serum s TNFR1 in the heavy and light medium groups in the experimental group were dynamic at different time points.The level of serum s TNFR1 in the medium and light medium groups increased in first days,reached the peak in the fourth day and then decreased.The level of serum s TNFR1 in the heavy group reached its peak for first days and continued to decline several days later.The results of comparison of serum s TNFR1 levels in each group after the same time point:The level of serum s TNFR1 level in severe dependence group was higher than that of moderate dependence group and mild reliance rent at first,seventh days,and the difference was statistically significant(P<0.001).There was no statistical differencebetween the fourth days(P>0.05).The level of serum s TNFR1 in the moderate dependent group was significantly higher than that mild dependence group at first and seventh days(P<0.001).there was no statistical difference between the fourth days(P>0.05).The comparison of the changes of serum s TNFR1 level at different time points in the prognosis group:The levels of serum s TNFR1 in severe dependence group,moderate dependence group and mild dependence group were significant at first,fourth,seventh days(P<0.001).The levels of serum s TNFR1 in mild dependence group began to rise on the first day after the injury and reached the peak and then decreased on the fourth day.The levels of serum s TNFR1 in themoderated and severe group reached the peak at first days after injury,and the level of serum was decreased on the fourth,seventh day.Conclusion:It is closely related between the serum s TNFR1 and the severity of craniocerebral injury combined with multiple trauma and the prignosis.Serum s TNFR1 level reflects the severity and prognosis of injury.The higher the degree of injury,the higher the level of serum s TNFR1,the worse the prognosis.The level of serum s TNFR1 can be used as an important biomarker to judge the severity and prognosis of craniocerebral injury combined with multiple trauma. |
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