The Expression and Clinical Significance of Myoglobin, Creatine Kinase and Inflammatory Mediators in Serum of Patients with Multiple Trauma Patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QINYanming ¹ ,  WANGPeng ¹ , LIZheng ¹ , LIYong ²

1. Department of Emergency, First People’s Hospital, Zhenjiang, Jiangsu 212001, P.R.China;
2. Department of Critical Care Medicine, First People’s Hospital, Zhenjiang, Jiangsu 212001, P.R.China;

Corresponding author：

WANGPeng, Email: zjwangpeng@163.com

Keywords：

Multiple trauma; Myoglobin; Creatine kinase; Inflammatory mediators; Multiple organ dysfunction syndrome

DOI：

10.7507/1671-6205.201606035

Video：

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Objective To investigate the dynamic expression and clinical significance of myoglobin, creatine kinase and inflammatory mediators in the serum of patients with multiple trauma. Methods From May 2013 to March 2015, 56 patients with multiple trauma admitted in EICU were recruited in the study. According to the injury severity, 56 patients were divided into a mild trauma group, a medium trauma group and a severe trauma group. The subjects were further divided into a MODS group and a non-MODS group based on multiple organ dysfunction syndrome (MODS) criteria. Twenty healthy adults undergoing physical examination were recruited as control. Serum myoglobin, creatine kinase, IL-6 and TNF-α levels were measured in the multiple trauma patients (1^st day, 3^rd day, 7^th day and 14^th day) and the controls. Results Compared with the controls, the serum levels of myoglobin, creatine kinase, IL-6 and TNF-α in the patients with multiple trauma increased significantly from 1^st to 14^th day after injury (allP＜0.05). Serum myoglobin, creatine kinase, IL-6 and TNF-α levels on 3^rd day after injury reached the peak, then decreased gradually in the mild, medium, and severe trauma groups, among which the changes of serum myoglobin, creatine kinase, IL-6 and TNF-α levels were significant on 3^rd day compared with other timepoints (allP＜0.05). On 1^st day after injury, serum levels ofmyoglobin, creatine kinase, IL-6 and TNF-α also differed significantly between the MODS group and non-MODS group (allP＜0.05). The AUCs of myoglobin, IL-6 and TNF-α for predicting MODS were 0.527-0.817, 0.641-0.890, and 0.197-0.544, respectively. Conclusions The dynamic changes of serum myoglobin, creatine kinase, IL-6 and TNF-α in patients with multiple trauma are correlated well with the injury severity and prognosis. Serum myoglobin, IL-6 and TNF-α levels may be good markers to predict secondary MODS in multiple trauma patients.

Citation： QINYanming, WANGPeng, LIZheng, LIYong. The Expression and Clinical Significance of Myoglobin, Creatine Kinase and Inflammatory Mediators in Serum of Patients with Multiple Trauma Patients. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(1): 50-54. doi: 10.7507/1671-6205.201606035 Copy

1.	Kashuk JL, Moore EE, Sawyer M, et al. Postinjury coagulopathy management: goal directed resuscitationvia POC thrombelastography. Ann Surg, 2010, 251(4): 604-614.
2.	Cowan JA Jr, Dubosh N, Hadley C. Seatbelt and helment depiction on the big screen blockbuster injury prevention messages. J Trauma, 2009, 66(3): 912-917.
3.	Tsukamoto T, Chanthaphavong RS, Pape HC. Current theories on the pathophysiology of multiple organ failure after trauma . Injury, 2010, 41(1): 21-26.
4.	Mommsen P, Frink M, Pape HC, et al. Elevated systemic IL-18 and neopterin levels are associated with posttraumatic complications among patients with multiple injuries: a prospective cohort study. Injury, 2009, 40(5): 528-534.
5.	Probst C, Hildebrand F, Griensven M, et al. Is dopexamine superior to dopamine in the treatment of multiple trauma patients--a prospective, double-blind, randomised study. Injury, 2010, 41(5): 499-505.
6.	Schroeder JE, Weiss YG, Mosheiff R. The current state in the evaluation and treatment of ARDS and SIRS. Injury, 2009, 40(Suppl 4): S82-S89.
7.	陈劲涛, 郁晓明. 多发伤患者血清酶含量及肌红蛋白肌钙蛋白Ⅰ水平变化及其意义. 中国急救医学, 2005, 25(10): 778-779.
8.	Sugimura T, Wang EL, Kashiwagi M, et al. Renal immuno- histochemical investigation for the differentiation of the cause of multiple trauma fatalities. Leg Med(Tokyo), 2012, 14(1): 1-5.
9.	徐善祥, 张茂, 干建新, 等. 多发伤患者血清肌红蛋白的动态变化及临床意义. 中华创伤杂志, 2011, 27(1): 12-16.
10.	Ahsan SK, Washington RJ, Ahsan N, et al. Myoglobinuria: evaluation of methods in the clinical diagnosis acute renal failure. Indian J Med Sci, 2001, 55(8): 443-452.
11.	Rupert SA. Pathogenesis and treatment of rhabdomyolysis. J Am Acad Nurse Pract, 2002, 14(2): 82-87.
12.	Kovar FM, Aldrian S, Endler G, et al. CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients. Wien Klin Wochenschr, 2012, 124(7-8): 245-250.
13.	Matsukawa A, Yoshimura T, Miyamoto K, et al. Analysis of the inflammatory cytokine network among TNF alpha, IL-1 beta, IL-1 receptor antagonist, and IL-8 in LPS-induced rabbit arthritis. Lab Invest, 1997, 76(5): 629-638.
14.	Utsunomiya I, Ito M, Oh-ishi S. Generation of inflammatory cytokines in zymosan-Induced pleurisy in rats: TNF induces IL-6 and cytokine-induced neutrophil chemoattractant (CINC)in vivo. Cytokine, 1998, 10(12): 956-963.
15.	Yadav K, Zehtabchi S, Nemes PC, et al. Early immunologic responses to trauma in the emergency department patients with major injuries. Resuscitation, 2009, 80(1): 83-88.
16.	Andrejaitiene J, Sirvinskas E, Zebrauskiene I. Procalcitonin:a new infection marker. Its use in intensive care. Medicina(Kaunas), 2002, 38(5): 491-498.
17.	Stensballe J, Christiansen M, Tonnesen E, et al. The early IL-6 and IL-10 response in trauma is correlated with injury severity and mortality. Acta Anaesthesiol Scand, 2009, 53(4): 515-521.
18.	Sun T, Wang X, Liu Z, et al. Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients. Injury, 2011, 42(7): 707-713.

1. Kashuk JL, Moore EE, Sawyer M, et al. Postinjury coagulopathy management: goal directed resuscitationvia POC thrombelastography. Ann Surg, 2010, 251(4): 604-614.
2. Cowan JA Jr, Dubosh N, Hadley C. Seatbelt and helment depiction on the big screen blockbuster injury prevention messages. J Trauma, 2009, 66(3): 912-917.
3. Tsukamoto T, Chanthaphavong RS, Pape HC. Current theories on the pathophysiology of multiple organ failure after trauma . Injury, 2010, 41(1): 21-26.
4. Mommsen P, Frink M, Pape HC, et al. Elevated systemic IL-18 and neopterin levels are associated with posttraumatic complications among patients with multiple injuries: a prospective cohort study. Injury, 2009, 40(5): 528-534.
5. Probst C, Hildebrand F, Griensven M, et al. Is dopexamine superior to dopamine in the treatment of multiple trauma patients--a prospective, double-blind, randomised study. Injury, 2010, 41(5): 499-505.
6. Schroeder JE, Weiss YG, Mosheiff R. The current state in the evaluation and treatment of ARDS and SIRS. Injury, 2009, 40(Suppl 4): S82-S89.
7. 陈劲涛, 郁晓明. 多发伤患者血清酶含量及肌红蛋白肌钙蛋白Ⅰ水平变化及其意义. 中国急救医学, 2005, 25(10): 778-779.
8. Sugimura T, Wang EL, Kashiwagi M, et al. Renal immuno- histochemical investigation for the differentiation of the cause of multiple trauma fatalities. Leg Med(Tokyo), 2012, 14(1): 1-5.
9. 徐善祥, 张茂, 干建新, 等. 多发伤患者血清肌红蛋白的动态变化及临床意义. 中华创伤杂志, 2011, 27(1): 12-16.
10. Ahsan SK, Washington RJ, Ahsan N, et al. Myoglobinuria: evaluation of methods in the clinical diagnosis acute renal failure. Indian J Med Sci, 2001, 55(8): 443-452.
11. Rupert SA. Pathogenesis and treatment of rhabdomyolysis. J Am Acad Nurse Pract, 2002, 14(2): 82-87.
12. Kovar FM, Aldrian S, Endler G, et al. CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients. Wien Klin Wochenschr, 2012, 124(7-8): 245-250.
13. Matsukawa A, Yoshimura T, Miyamoto K, et al. Analysis of the inflammatory cytokine network among TNF alpha, IL-1 beta, IL-1 receptor antagonist, and IL-8 in LPS-induced rabbit arthritis. Lab Invest, 1997, 76(5): 629-638.
14. Utsunomiya I, Ito M, Oh-ishi S. Generation of inflammatory cytokines in zymosan-Induced pleurisy in rats: TNF induces IL-6 and cytokine-induced neutrophil chemoattractant (CINC)in vivo. Cytokine, 1998, 10(12): 956-963.
15. Yadav K, Zehtabchi S, Nemes PC, et al. Early immunologic responses to trauma in the emergency department patients with major injuries. Resuscitation, 2009, 80(1): 83-88.
16. Andrejaitiene J, Sirvinskas E, Zebrauskiene I. Procalcitonin:a new infection marker. Its use in intensive care. Medicina(Kaunas), 2002, 38(5): 491-498.
17. Stensballe J, Christiansen M, Tonnesen E, et al. The early IL-6 and IL-10 response in trauma is correlated with injury severity and mortality. Acta Anaesthesiol Scand, 2009, 53(4): 515-521.
18. Sun T, Wang X, Liu Z, et al. Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients. Injury, 2011, 42(7): 707-713.

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The Expression and Clinical Significance of Myoglobin, Creatine Kinase and Inflammatory Mediators in Serum of Patients with Multiple Trauma Patients

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