Buyukaslan Hasan, Gulacti Umut, Gökdemir Mehmet Tahir, Giden Ramazan, Celik Hakim, Erel Özcan, Dörterler Erman Mustafa
Department of Emergency Medicine, Harran University Education and Research Hospital, Şanliurfa, Turkey.
Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey.
Eur J Trauma Emerg Surg. 2019 Feb;45(1):167-174. doi: 10.1007/s00068-017-0900-9. Epub 2018 Jan 11.
Gunshot injuries result in serious traumatic tissue damage due to high velocity of the bullet, deep penetration, and ballistic effect. Trauma is known to be related with oxidative stress. Serum thiol levels and disulphide/thiol homeostasis are novel oxidative stress biomarkers. In this study, we aimed to investigate serum thiol levels and disulphide/thiol homeostasis in injury patterns of patients admitted to the emergency department with a gunshot injury.
A total of 128 participants were included in the study. The participants were divided into two groups: the patient group (Group 1; n = 73) and healthy controls (Group 2; n = 55). Native thiol, total thiol, disulphide levels, disulphide/native thiol, disulphide/total thiol, and neutrophil-to-lymphocyte ratio (NLR) were measured. The Revised Trauma Scale (RTS) and Glasgow Coma Scale (GCS) scores were calculated.
Native thiol, total thiol, and disulphide levels were significantly lower in Group 1 (p < 0.001). Disulphide/native thiol ratio, disulphide/total thiol ratio, and NLR were significantly higher in Group 1, compared to Group 2 (p < 0.05). There was a positive correlation between thiol levels and RTS and GCS scores and NLR. Stepwise linear regression analysis showed that native thiol was an independent indicator of RTS and GCS scores. The receiver operating characteristic curve (ROC) analysis revealed that serum native thiol levels of ≤ 342.9 could predict gunshot injury with a sensitivity of 82% and a specificity of 77% (area under the curve = 0.853; 95% confidence interval 0.783-0.924).
Our study results suggest that thiol-disulphide homeostasis is disrupted in patients sustaining gunshot injuries, and thiol levels decrease in correlation with the severity of trauma with a high sensitivity and specificity. As the level of native thiol is an independent predictor of the severity of trauma, reduced thiol levels may be of prognostic value in the early assessment of patients in the emergency room.
由于子弹速度快、穿透力强和弹道效应，枪伤会导致严重的创伤性组织损伤。已知创伤与氧化应激有关。血清硫醇水平和二硫键/硫醇稳态是新的氧化应激生物标志物。在本研究中，我们旨在调查因枪伤入住急诊科患者的损伤模式中的血清硫醇水平和二硫键/硫醇稳态。
本研究共纳入128名参与者。参与者分为两组：患者组（第1组；n = 73）和健康对照组（第2组；n = 55）。测量天然硫醇、总硫醇、二硫键水平、二硫键/天然硫醇、二硫键/总硫醇以及中性粒细胞与淋巴细胞比值（NLR）。计算修订创伤量表（RTS）和格拉斯哥昏迷量表（GCS）评分。
第1组的天然硫醇、总硫醇和二硫键水平显著较低（p < 0.001）。与第2组相比，第1组的二硫键/天然硫醇比值、二硫键/总硫醇比值和NLR显著更高（p < 0.05）。硫醇水平与RTS、GCS评分和NLR之间存在正相关。逐步线性回归分析表明，天然硫醇是RTS和GCS评分的独立指标。受试者工作特征曲线（ROC）分析显示，血清天然硫醇水平≤342.9可预测枪伤，敏感性为82%，特异性为77%（曲线下面积 = 0.853；95%置信区间0.783 - 0.924）。
我们的研究结果表明，枪伤患者的硫醇 - 二硫键稳态受到破坏，硫醇水平与创伤严重程度相关且具有高敏感性和特异性。由于天然硫醇水平是创伤严重程度的独立预测指标，降低的硫醇水平可能在急诊室患者的早期评估中具有预后价值。
