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目的:探讨大面积烧伤患者血清透明质酸(HA)浓度变化与肝细胞损伤的关系。方法:采用放射免疫和酶联免疫吸附等技术,检测烧伤严重程度不同及其并发全身性炎症反应综合症(SIRS)、多脏器功能障碍综合症(MODS)、多脏器功能衰竭(MOF)和死亡患者各组血清 HA、肿瘤坏死因子α(TNFα)和临床常规肝肾功指标。结果:烧伤后2周内,血清 HA 浓度一直维持高水平,并随烧伤严重程度增加和 SIRS,MODS 的产生,其数值逐步升高、相差显著(P<0.001),但在 MODS 向 MOF 发展、至残废前后,血清 HA 值又由高限急剧降低;直线相关分析显示,血清 HA 浓度变化与烧伤严重程度和 SIRS 等并发症的发生发展密切相关(P<0.01),与血清 TNFα和谷草转氨酶、总胆红素值呈正相关(P<0.05～0.01),而与血浆白蛋白、白蛋白/球蛋白比值呈负相关(P<0.05)。结论:血清 HA 浓度中、重度升高可能与 TNFα等持续损伤肝内皮细胞的降解功能有关,可将其作为临床大面积烧伤患者肝损伤、病情严重程度和预后判断的敏感指标。
Objective: To investigate the relationship between serum hyaluronic acid (HA) concentration and hepatocellular injury in patients with extensive burn. Methods: Radioimmunoassay and enzyme-linked immunosorbent assay were used to detect the severity of burns and their relationship with systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), multiple organ failure (MOF) And the serum levels of tumor necrosis factor alpha (TNFα) and clinical indicators of liver and kidney function in each group. Results: Within 2 weeks after burn, the concentration of serum HA remained high, with the increase of burn severity and the production of SIRS and MODS, the value of serum HA increased gradually with a significant difference (P <0.001) The level of serum HA decreased sharply from the high limit to the level of disability. The linear correlation analysis showed that the change of serum HA level was closely related to the severity of burn and the incidence of complications such as SIRS (P <0.01) Total bilirubin value was positively correlated (P <0.05-0.01), but negatively correlated with plasma albumin and albumin / globulin (P <0.05). CONCLUSION: Serum HA concentration may be related to the degradation of hepatic endothelial cells such as TNFα, which may be used as a sensitive indicator of liver injury, severity of disease and prognosis in patients with extensive area burn.