脓毒症内皮细胞损伤与炎症、凝血相关性研究(1)
【摘要】目的 观察脓毒症患者内皮细胞功能、炎症因子以及凝血指标的表达，探讨三者的关系。
方法 采用前瞻性对照研究方法。选择宁夏医科大学总医院重症监护病房(ICU)收治的70例危重病患者，依据脓毒症及全身炎症反应综合征(systemic inflammatory response syndrome， SIRS)诊断标准分为脓毒症组38例、SIRS组32例。另选取健康体检者20例作为健康对照组。Sepsis组和SIRS组患者在高血压、糖尿病及其并发症构成有可比性。各组性别、年龄构成、吸烟、饮酒状况、体质量指数(BMI)方面相匹配有可比性。患者于入住ICU 24 h内抽取晨起空腹肘静脉血6 ml，分离血浆。采用双抗体夹心ABC酶联免疫吸附(ELISA)法测定标本中sCD62P水平、TNFα水平。同时测定超敏C反应蛋白(hsCRP)水平和血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D二聚体(Ddimer)水平、抗凝血酶Ⅲ活性(ATⅢ)；收集纳入研究患者的临床资料，进行SOFA评分；所有数据采用SPSS 17.0版统计软件进行分析。多组间比较采用单因素方差分析，对于非配对方差不齐资料，采用非参数法秩和检验(Keuskal Wallis)，比较分析各组sCD62P水平、炎症因子和凝血指标的差异，并采用Pearson相关分析法分析sCD62P水平与上述炎症因子和凝血指标的相关性。以P<0.05为差异具有统计学意义。
, 百拇医药
结果 ① 与健康对照组和SIRS组比较：脓毒症组sCD62P水平、hsCRP和TNFα水平均明显升高 (P<0.05)；② 与健康对照组比较：脓毒症组和SIRS组Ddimer、PT、APTT均显著升高，而PLT计数、ATⅢ活性显著降低(P<0.05)；③ 脓毒症患者hsCRP和TNFα分别与Ddimer、PT、APTT呈正相关，而与PLT计数、ATⅢ活性呈负相关 (P<0.05)；④ sCD62P水平与hsCRP、TNFα、Ddimer、PT和APTT明显正相关，而与PLT计数、ATⅢ活性呈明显负相关(P<0.05)。
结论 脓毒症患者血浆sCD62P的表达明显增高，是内皮细胞损伤的早期生物标志物；炎症与凝血功能障碍相互作用促进了脓毒症的发生和发展；可溶性颗粒膜蛋白CD62P是脓毒症炎症凝血网络形成的重要始动因素。
【关键词】脓毒症；内皮细胞损伤；可溶性颗粒膜蛋白CD62P；炎症因子；凝血功能
, 百拇医药
Endothelial cell injury correlates with inflammatory cytokine and coagulation in the patients with sepsis DING Huan，CAO Xiangyuan，MA Xigang，ZHOU Wenjie. Intensive Care Unit，The General Hospital of Ningxia Medical University，Yinchuan 750004，China
Corresponding author：DING Huan，Email：iresrainbow@sina.com
【Abstract】Objective To observe the clinical findings about the endothelial cell injury related to the genesis of inflammatory cytokines and coagulation. Methods A total of 70 critically ill patients with SIRS (systemic inflammatory response syndrome) admitted to intensive care unit(ICU)between September 2009 and February 2010 were enrolled for a prospective and control study. According to diagnostic criteria of Sepsis/SIRS，the patients were divided into two groups：sepsis group (n=38) and SIRS group (n=32)，and another 20 healthy volunteers served as control group. Patients in the sepsis group and SIRS group were matched by clinical signs of high blood pressure，diabetes and its complications.The demographics of patients including age，sex，body mass index (BMI)，smoking and alcohol addict were comparable among the different groups.The 6 ml peripheral blood samples were collected within 24 h after admission to ICU for enzymelinked immunosorbent assay (ELISA) to detect the plasma levels of sCD62P， TNFα， and hsCRP. And variables of coagulation function such as platelet (PLT)，prothrombin time (PT)，activated partial thromboplastin time (APTT)，Ddimer and antithrombinⅢ (ATⅢ) were analyzed during 24 h after admission to ICU. Meanwhile sequential organ failure assessment (SOFA) score of critically ill patients was evaluated. Data were expressed in mean±standard deviation and were statistically analyzed by using SPSS 17.0 statistical software.The differences in plasma levels of sCD62P of patients in each group were analyzed by ANOVA and Kruskal Wallis test.The relationship between sCD62P and inflammatory cytokines as well as with coagulation were determined by Pearson correlation analysis.Changes were considered as statistically significant if P value was less than 0.05. Results ① Compared with control group and SIRS group， the levels of sCD62P，TNFα and high sensitive Creactive protein (hsCRP) were significantly higher in sepsis group (P<0.05). ② The plasma levels of Ddimer，PT，APTT in sepsis group and SIRS group were significantly higher than those in control group，while the platelet count (PLT) and the activity of ATⅢ were obviously lower (P<0.05). ③ In sepsis group， the plasma levels of hsCRP and TNFα positively correlated with PT，APTT，Ddimer， and negatively correlated with ATⅢ，PLT (P<0.05). ④ Plasma levels of sCD62P were significantly correlated with plasma levels of TNFα，hsCRP，Ddimer，PT，APTT，whereas correlated negatively well with PLT，ATⅢ (P<0.05).Conclusions The plasma sCD62P concentration is elevated as a early biomarker in patients with sepsis， and it acted as one of pathogenic factors responsible for endothelial cell damage. Coagulation and mediators of inflammation promotes each other，aggravating the severity of the sepsis. The plasma sCD62P may be the important factor associated with initiation of coagulation development and inflammatory reaction., http://www.100md.com(丁欢 曹相原 马希刚 周文杰)
方法 采用前瞻性对照研究方法。选择宁夏医科大学总医院重症监护病房(ICU)收治的70例危重病患者，依据脓毒症及全身炎症反应综合征(systemic inflammatory response syndrome， SIRS)诊断标准分为脓毒症组38例、SIRS组32例。另选取健康体检者20例作为健康对照组。Sepsis组和SIRS组患者在高血压、糖尿病及其并发症构成有可比性。各组性别、年龄构成、吸烟、饮酒状况、体质量指数(BMI)方面相匹配有可比性。患者于入住ICU 24 h内抽取晨起空腹肘静脉血6 ml，分离血浆。采用双抗体夹心ABC酶联免疫吸附(ELISA)法测定标本中sCD62P水平、TNFα水平。同时测定超敏C反应蛋白(hsCRP)水平和血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D二聚体(Ddimer)水平、抗凝血酶Ⅲ活性(ATⅢ)；收集纳入研究患者的临床资料，进行SOFA评分；所有数据采用SPSS 17.0版统计软件进行分析。多组间比较采用单因素方差分析，对于非配对方差不齐资料，采用非参数法秩和检验(Keuskal Wallis)，比较分析各组sCD62P水平、炎症因子和凝血指标的差异，并采用Pearson相关分析法分析sCD62P水平与上述炎症因子和凝血指标的相关性。以P<0.05为差异具有统计学意义。
, 百拇医药
结果 ① 与健康对照组和SIRS组比较：脓毒症组sCD62P水平、hsCRP和TNFα水平均明显升高 (P<0.05)；② 与健康对照组比较：脓毒症组和SIRS组Ddimer、PT、APTT均显著升高，而PLT计数、ATⅢ活性显著降低(P<0.05)；③ 脓毒症患者hsCRP和TNFα分别与Ddimer、PT、APTT呈正相关，而与PLT计数、ATⅢ活性呈负相关 (P<0.05)；④ sCD62P水平与hsCRP、TNFα、Ddimer、PT和APTT明显正相关，而与PLT计数、ATⅢ活性呈明显负相关(P<0.05)。
结论 脓毒症患者血浆sCD62P的表达明显增高，是内皮细胞损伤的早期生物标志物；炎症与凝血功能障碍相互作用促进了脓毒症的发生和发展；可溶性颗粒膜蛋白CD62P是脓毒症炎症凝血网络形成的重要始动因素。
【关键词】脓毒症；内皮细胞损伤；可溶性颗粒膜蛋白CD62P；炎症因子；凝血功能
, 百拇医药
Endothelial cell injury correlates with inflammatory cytokine and coagulation in the patients with sepsis DING Huan，CAO Xiangyuan，MA Xigang，ZHOU Wenjie. Intensive Care Unit，The General Hospital of Ningxia Medical University，Yinchuan 750004，China
Corresponding author：DING Huan，Email：iresrainbow@sina.com
【Abstract】Objective To observe the clinical findings about the endothelial cell injury related to the genesis of inflammatory cytokines and coagulation. Methods A total of 70 critically ill patients with SIRS (systemic inflammatory response syndrome) admitted to intensive care unit(ICU)between September 2009 and February 2010 were enrolled for a prospective and control study. According to diagnostic criteria of Sepsis/SIRS，the patients were divided into two groups：sepsis group (n=38) and SIRS group (n=32)，and another 20 healthy volunteers served as control group. Patients in the sepsis group and SIRS group were matched by clinical signs of high blood pressure，diabetes and its complications.The demographics of patients including age，sex，body mass index (BMI)，smoking and alcohol addict were comparable among the different groups.The 6 ml peripheral blood samples were collected within 24 h after admission to ICU for enzymelinked immunosorbent assay (ELISA) to detect the plasma levels of sCD62P， TNFα， and hsCRP. And variables of coagulation function such as platelet (PLT)，prothrombin time (PT)，activated partial thromboplastin time (APTT)，Ddimer and antithrombinⅢ (ATⅢ) were analyzed during 24 h after admission to ICU. Meanwhile sequential organ failure assessment (SOFA) score of critically ill patients was evaluated. Data were expressed in mean±standard deviation and were statistically analyzed by using SPSS 17.0 statistical software.The differences in plasma levels of sCD62P of patients in each group were analyzed by ANOVA and Kruskal Wallis test.The relationship between sCD62P and inflammatory cytokines as well as with coagulation were determined by Pearson correlation analysis.Changes were considered as statistically significant if P value was less than 0.05. Results ① Compared with control group and SIRS group， the levels of sCD62P，TNFα and high sensitive Creactive protein (hsCRP) were significantly higher in sepsis group (P<0.05). ② The plasma levels of Ddimer，PT，APTT in sepsis group and SIRS group were significantly higher than those in control group，while the platelet count (PLT) and the activity of ATⅢ were obviously lower (P<0.05). ③ In sepsis group， the plasma levels of hsCRP and TNFα positively correlated with PT，APTT，Ddimer， and negatively correlated with ATⅢ，PLT (P<0.05). ④ Plasma levels of sCD62P were significantly correlated with plasma levels of TNFα，hsCRP，Ddimer，PT，APTT，whereas correlated negatively well with PLT，ATⅢ (P<0.05).Conclusions The plasma sCD62P concentration is elevated as a early biomarker in patients with sepsis， and it acted as one of pathogenic factors responsible for endothelial cell damage. Coagulation and mediators of inflammation promotes each other，aggravating the severity of the sepsis. The plasma sCD62P may be the important factor associated with initiation of coagulation development and inflammatory reaction., http://www.100md.com(丁欢 曹相原 马希刚 周文杰)