Clinical Study Of The Change Of Serum Myohemoglobin And Its Significance In Severe Multiple Trauma Patients

Background:Trauma is a common problem faced in the world,and trauma care is a competitive issue to the modern medicine.To explore a simple and effective clinical marker becomes one direction in trauma research,myohemoglobin(Mb) is now widely used in acute myocardial infarction and rhabdomyolysis as a useful marker reflecting muscle injure degree,but its expression and significance in multiple trauma patients is not clearly known.Objective:To investigate the dynamic change of serum Mb activity of patients with multiple trauma and the relationship beween serum Mb and severity,other markers of trauma patients,then explore the factors which influence serum Mb to change and its significance.Methods:It' s a prospective observation study.41 patients with multiple trauma treated in emergency intensive care unit(EICU) were enrolled in this study from Jun 2008 to Feb 2009.Serum Mb,Hepatic function parameter[Alanine aminotransferase(ALT), Aspartate aminotransferase(AST),albumin(ALB),cholinesterase(ChE)],myocardial enzymogram[creatine kinase(CK),isoenzymes of creatine kinase(CK-MB), troponin i(cTnI ) lactate dehydrogenase(LDH)],renal functional parameter [blood urea nitrogen(BUN ),creatinine(Cr )],inflammatory reaction parameter [C-reactive protein(CRP),proto-calcitonin(PCT )],Blood routine parameter [white blood cell count(WBC ),neutrophil percentage(NE%),blood platelet count(PLT )]in patients were detected at 1,3,7,14d after trauma.The injury severity score(ISS),the simplified acute physiology scoreⅡ(SAPSⅡ),the Glasgow coma score(GCS),the percentage of injured muscle and soft tissue to the total body, and with or without chest trauma and shock were recorded simultaneously after admission to EICU.Using statistic software SPSS 13.0 or SigmaStat3.5,The change of serum Mb activity of patients was analyzed.The relationships between serum Mb and ISS,SAPSⅡ,GCS,the percentage of injured muscle and soft tissue to the total body,chest trauma, shock were analyzed.The relationships between serum Mb and ALT,AST,LDH,ALB, ChE,PCT,CRP,CK,CK-MB,cTnI,BUN,Cr,WBC,PLT,NE%were analyzed respectively,gradually linear regression analysis was used to chose the significant correlated markers with serum Mb during different time point,We then analyzed the relationships between myocardial enzymogram and ISS,prognosis respectively,Finally, the values of serum Mb and CK to judge prognosis and the occurrence of acute renal failure were compared and analyzed.Results:The levels of serum Mb significantly increased after trauma and continuously decreased as time passed,the levels of serum Mb in patients with ISS≥25 were significant higher and decreased more slowly than that in patients with ISS＜25.The levels of serum Mb in Non-survivors first ascended,and peaked 3 days after trauma, then slowly decreased,while that levels in survivors were significantly lower and all decreased after trauma.The levels of serum Mb significantly correlated with SAPSⅡat 1 d;significantly correlated with ISS at 7,14d;significantly correlated with shock at 1,3d;significantly correlated with the percentage of injured muscle and soft tissue to the total body at 1d; while negatively correlated with GCS at 3,7,14d.The levels of serum Mb also significantly correlated with ALT,AST,LDH,CK,CK-MB,Cr at the corresponding time points,and significantly correlated with BUN at 1,3,7d,significantly correlated with CRP at 3,7,14d,negatively correlated with ALB,PLT at 1,7,14d.Serum Mb and other related parameters were analyzed by gradual regressive analysis,shock and Cr in the first day,shock and CK at 3d,CK-MB,Cr and ChE at 7d,CK,CK-MB,ALB,AST at 14d were significantly related with serum Mb concentration changing.Serum Mb and routine cardiac enzyme parameters were significantly related the injury severity and prognosis,especially Mb,CK,LDH.Serum CK increased dramatically after trauma,and peaked at 3 d,in patients that ISS≥25,serum CK peaked at 3 d,while in patiens that ISS＜25,it decreased gradually.Serum CK increased persistently in patients that resulted dead,while persistently decreased in survive.we find that Mb and CK were good predicting markers for prognosis and renal failure in multiple trauma patients,using ROC curve to compare the area under curve.especially at 1 d Mb is better than CK in predicting prognosis and renal failure.Conclusion:Multiple trauma patients have variablely increased serum Mb concentration,that related with trauma severiy,muscle injury degree,shock,inflammation response etc.It's dynamic changing pattern might be an effective marker for monitoring the severity and prognosis of multiple trauma patients.