血浆DNA作为创伤患者的预后标志物。

Plasma DNA as a prognostic marker in trauma patients.

作者信息

Lo Y M, Rainer T H, Chan L Y, Hjelm N M, Cocks R A

机构信息

Department of Chemical Pathology and Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR.

出版信息

Clin Chem. 2000 Mar;46(3):319-23.

PMID:10702517

Abstract

BACKGROUND

Recently, much interest has developed in the potential use of plasma DNA as a diagnostic and monitoring tool. We hypothesized that plasma DNA is increased in patients with trauma and may be prognostic in such patients.

METHODS

We studied 84 patients who had sustained an acute blunt traumatic injury. We measured plasma DNA by a real-time quantitative PCR assay for the beta-globin gene. Blood samples were collected at a median time of 60 min following injury. Blood samples were also obtained from 27 control subjects.

RESULTS

The median plasma DNA concentrations in the control, minor/moderate trauma (Injury Severity Score <16; n = 47), and major trauma (Injury Severity Score > or =16; n = 37) groups were 3154 kilogenome-equivalents/L, 13 818 kilogenome-equivalents/L, and 181 303 kilogenome-equivalents/L, respectively. Plasma DNA concentrations in patients with adverse outcomes, including acute lung injury, acute respiratory distress syndrome, and death, had 11. 6- to 12-fold higher plasma DNA concentrations than those who did not develop these complications. At a cutoff of 232 719 kilogenome-equivalents/L, the sensitivities of plasma DNA analysis for the prediction of acute lung injury, acute respiratory distress syndrome, and death were 100% (95% confidence interval, 100-100%), 100% (95% confidence interval, 100-100%), and 78% (95% confidence interval, 40-97%), respectively. The respective specificities were 81% (95% confidence interval, 71-89%), 80% (95% confidence interval, 70-88%), and 82% (95% confidence interval, 71-90%).

CONCLUSIONS

Plasma DNA is increased after trauma and may be a potentially valuable prognostic marker for these patients.

摘要

背景

最近，人们对血浆DNA作为一种诊断和监测工具的潜在用途产生了浓厚兴趣。我们假设创伤患者的血浆DNA水平会升高，并且可能对这类患者具有预后价值。

方法

我们研究了84例遭受急性钝性创伤的患者。通过针对β-珠蛋白基因的实时定量PCR测定法测量血浆DNA。在受伤后中位时间60分钟采集血样。还从27名对照受试者中获取了血样。

结果

对照组、轻度/中度创伤（损伤严重度评分<16；n = 47）组和重度创伤（损伤严重度评分≥16；n = 37）组的血浆DNA浓度中位数分别为3154千基因组当量/升、13818千基因组当量/升和181303千基因组当量/升。出现不良结局（包括急性肺损伤、急性呼吸窘迫综合征和死亡）的患者的血浆DNA浓度比未发生这些并发症的患者高11.6至12倍。在血浆DNA分析预测急性肺损伤、急性呼吸窘迫综合征和死亡的临界值为232719千基因组当量/升时，其敏感性分别为100%（95%置信区间，100 - 100%）、100%（95%置信区间，100 - 100%）和78%（95%置信区间，40 - 97%）。各自的特异性分别为81%（95%置信区间，71 - 89%）、80%（95%置信区间，70 - 88%）和82%（95%置信区间，71 - 90%）。