Department of Surgery, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
J Trauma Acute Care Surg. 2012 Apr;72(4):999-1005. doi: 10.1097/TA.0b013e3182413bd8.
We observed that serum transthyretin (TTR) levels consistently remain low when patients' general conditions are poor, despite adequate nutritional support. We conducted this study to analyze the changes of serum TTR over time from injury in massively-burned patients and verify the validity of prediction by clinical outcomes, which are assessed via serum TTR in the early postburn period.
From January 2005 to December 2010, the samples of serum TTR from 471 burn patients (mean % total body surface area [TBSA] burned, 51% ± 20%) were analyzed with time frames from injury retrospectively.
Serum TTR significantly decreased during the period from day 5 to day 10 postinjury in both the survival group (n = 290, mean %TBSA burned, 42.9% ± 14.2%) and nonsurvival group (n = 181, mean %TBSA burned, 64.6% ± 20.8%). However, after this period, the serum TTR constantly increased in the survival group but remained low in nonsurvivors. At all time, the levels of serum TTR obtained from survivors were significantly higher than those of nonsurvivors. The serum TTR had weak correlation with the extent of the burn injury (r = -0.234). Survival rates of the patients increased significantly by the increase of the serum TTR of early postburn period. In multivariable model, age (odds ratio [OR], 1.054; 95% confidence interval [CI], 1.043-1.066; p = 0.000), TBSA burned (OR, 1.058; 95% CI, 1.051-1.066; p = 0.000), sex (OR, 0.720; 95% CI, 0.547-0.947; p = 0.019), and serum TTR during early postburn period (OR, 1.05; 95% CI, 0.873-0.972; p = 0.003) were independently associated with mortality.
The serum TTR of early postburn period can be used as a prognostic markers, and low serum TTR can be used as a signal for screening out the patients at risk who need careful assessment and monitoring at an early stage.
我们观察到，尽管给予了充分的营养支持，当患者一般情况较差时，血清转甲状腺素蛋白（TTR）水平仍持续较低。我们进行这项研究，以分析大面积烧伤患者从受伤到时间推移的血清 TTR 变化，并验证通过早期烧伤后血清 TTR 评估的临床结局预测的有效性。
从 2005 年 1 月至 2010 年 12 月，回顾性分析了 471 例烧伤患者（平均总体表烧伤面积 [TBSA] 烧伤，51%±20%）的血清 TTR 样本。
在生存组（n=290，平均 TBSA 烧伤，42.9%±14.2%）和非生存组（n=181，平均 TBSA 烧伤，64.6%±20.8%）中，伤后第 5 至第 10 天，血清 TTR 均显著下降。然而，在此期间后，生存组的血清 TTR 持续增加，而非幸存者则保持低水平。在所有时间点，幸存者的血清 TTR 水平均明显高于非幸存者。血清 TTR 与烧伤损伤程度呈弱相关（r=-0.234）。早期烧伤后血清 TTR 升高，患者生存率显著提高。在多变量模型中，年龄（比值比 [OR]，1.054；95%置信区间 [CI]，1.043-1.066；p=0.000）、TBSA 烧伤（OR，1.058；95%CI，1.051-1.066；p=0.000）、性别（OR，0.720；95%CI，0.547-0.947；p=0.019）和早期烧伤后血清 TTR（OR，1.05；95%CI，0.873-0.972；p=0.003）与死亡率独立相关。
早期烧伤后血清 TTR 可作为预后标志物，低血清 TTR 可作为筛选早期需要仔细评估和监测的高危患者的信号。
