[Preliminary analysis of serum enzymes indicators in childhood amputees due to earthquake resulting trauma].
OBJECTIVE
To retrospectively analyze the serum enzymes in childhood amputees as a result of earthquake, and to discuss their clinical significance.


METHODS
From 150 children amputees who were victims of Sichuan Wenchuan earthquake in 2008 and Sichuan Lushan earthquake in 2013, 45 cases with complete records of serum enzymes examinations were reviewed retrospectively. They were divided into three groups: amputation group (n=6), fasciotomy decompression group (n=5), general trauma without injury to extremity group (n=34). Serum enzyme examination data were compared for statistical analysis to find the difference among groups. Ten children who were not victims of earthquake were selected from department of orthopaedics to serve as controls, and 20 adult amputees as a result of earthquake served as another control group.


RESULTS
There were significant differences in injury severity scale (ISS) and the contents of all serum enzymes, including aspartate transaminase (AST), alanine aminotransferase (ALT), creatine kinase (CK), lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH), between the amputation group and other patients (FISS=15.474, P<0.001; FAST=10.770, P<0.001; FALT=12.799, P<0.001; FCK=12.848, P<0.001; FLDH=13.126, P<0.001; FHBDH=13.186, P<0.001), and the difference in amputation group was even more significant. AST, LDH, HBDH in childhood amputees group were significantly higher than those in adult amputation group. The contents of ALT and CK were slightly increased. Serum enzyme contents were found to be significantly helpful for prediction of disease condition and prognosis. It was also found that CK was extremely helpful in assessing the degree of illness in patients with severe trauma, especially in patients complicated by severe soft tissue injury. In all the groups, of patients, it was found that CK rose from (129±62) U/L in non-earthquake induced trauma group to (44 208±39,788) U/L in earthquake amputation group, and it was thus increased more than 300 times. Its highest value even reached 117,513 U/L, which was more than 840 times of the normal. If a timely amputation or muscle compartment decompression was performed, CK might decline rapidly down to the normal value.


CONCLUSIONS
The comprehensive and continuous assessment of serum enzymes is mandatory during the treatment of children with acute trauma. It is of important clinical significance to correctly judge the condition and to determine optional treatment measures.
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China. Corresponding author: Jiang Xin, Email: jiangxin@cd120.com.
Xin
X
Jiang
Lijun
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Liu
Hui
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Li
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000674:Amputees; D001219:Aspartate Aminotransferases / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D004190:Disasters; D055866:Earthquakes; D005260:Female; D006801:Humans; D006884:Hydroxybutyrate Dehydrogenase / Q000097:blood; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D012189:Retrospective Studies; D044967:Serum / Q000201:enzymology*; D014947:Wounds and Injuries / Q000097:blood*
D007770:L-Lactate Dehydrogenase; D006884:Hydroxybutyrate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase