Objective To investigate the changes in serum myocardial zymogram indexes ［lactate dehydrogenase (LDH) and aspartate aminotransferase (AST), creatine kinase isoenzyme (CK-MB), creatine kinase (CK)］ of patients with multiple injuries of different severity and their predictive value for cardiac dysfunction in multiple organ dysfunction syndrome (MODS).
Methods A total of 67 patients with multiple injuries were selected as the research subjects. According to the injury severity score (ISS) criteria, patients with multiple injuries were divided into mild multiple injury group (n=20), moderate multiple injury group (n=26) and severe multiple injury group (n=21). According to the MODS standard, they were divided into MODS group and non-MODS group. The LDH,AST,CK-MB and CK levels of severe multiple injury group, moderate multiple injury group and mild multiple injury group were compared on the 1st, 2nd and 3rds day after injury. The LDH, AST, CK-MB and CK levels were compared between MODS group and non-MODS group on the 1st, 2nd, and 3rd days after injury. Spearman rank correlation was used to analyze the correlation of LDH, AST, CK-MB and CK levels with disease severity, combined chest and abdominal sites in patients with multiple injuries, and cardiac dysfunction in patients with multiple injuries and MODS. The predictive value of LDH, AST, CK-MB and CK levels in cardiac dysfunction in patients with multiple injuries with MODS was analyzed.
Results APACHEⅡ score, number of MODS and MODS score in severe multiple injury group were higher than those in moderate multiple injury group and mild multiple injury group, while APACHEⅡ score, number of MODS and MODS score in moderate multiple injury group were higher than those in mild multiple injury group (P＜0.05). The levels of LDH, AST, CK-MB and CK in severe multiple injury group, moderate multiple injury group and mild multiple injury group all showed a decreasing trend on the 1st, 2nd and 3rd days after injury, while the levels of LDH, AST, CK-MB and CK in severe multiple injury group were higher than those in moderate multiple injury group and mild multiple injury group. The levels of LDH, AST, CK-MB and CK in moderate multiple injury group were higher than those in mild multiple injury group. The levels of LDH, AST, CK-MB and CK in MODS group and non-MODS group showed a gradually decreasing trend, and the levels of LDH, AST, CK-MB and CK in MODS group were higher than those in non-MODS group; The difference of interaction between groups, time points and time points between groups were statistically significant (P＜0.05). Spearman rank correlation analysis showed that on the 1st, 2nd and 3rd days after injury, LDH, AST, CK-MB and CK levels were positively correlated with the severity of disease and combined chest and abdominal sites in patients with multiple injuries, and with cardiac dysfunction in patients with multiple injuries and MODS (P＜0.05). On the 1st day, receiver operating characteristic (ROC) curve showed that LDH, AST, CK-MB and CK had predictive value for cardiac dysfunction in patients with multiple injuries and MODS (P＜0.05).
Conclusion The levels of serum myocardial zymogram increase with the aggravation of patients with multiple injuries, which are positively correlated with the severity of patients with multiple injuries, combined chest and abdominal sites and the cardiac dysfunction in the occurrence of MODS, and are also risk factors for the cardiac dysfunction in the occurrence of MODS in patients with multiple injuries.
