脓毒症患者血清中炎性因子、组织因子和组织因子途径抑制物水平变化及临床意义
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摘要
目的探讨脓毒症患者血清中炎性因子、组织因子(TF)及组织因子途径抑制物(TFPI)水平的变化及临床意义。方法选择2012年1月至2015年12月郑州市儿童医院收治的89例脓毒症患者为研究对象,根据患者病情分为脓毒症组(n=61)、严重脓毒症组(n=17)和脓毒性休克组(n=11)。各组患者入院后立即采集静脉血2 m L,采用酶联免疫吸附试验检测血清中C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、TF及TFPI水平,采用电化学发光法检测血清中降钙素原(PCT)水平;并分析各指标与小儿危重病例评分(PCIS)的相关性。结果严重脓毒症组和脓毒性休克组患者血清中CRP、TNF-α、PCT及TF水平高于脓毒症组,TFPI水平低于脓毒症组(P <0. 05);脓毒性休克组患者血清中CRP、TNF-α、PCT和TF水平高于严重脓毒血组,TFPI水平低于严重脓毒症组(P <0. 05)。脓毒症患者血清中CRP、TNF-α、PCT及TF水平与PCIS呈显著负相关(r=-0. 76、-0. 72、-0. 81、-0. 70,P <0. 05),TFPI水平与PCIS呈显著正相关(r=0. 73,P <0. 05)。结论血清中CRP、TNF-α、PCT、TF及TFPI水平在评估脓毒症患者的病情严重程度中具有一定的价值,CRP、TNF-α、PCT及TF水平越高,TFPI水平越低,患者病情越严重。
Objective To investigate the changes and clinical significance of serum levels of inflammatory factors,tissue factor( TF) and tissue factor pathway inhibitor( TFPI) in patients with sepsis. Methods Eighty-nine patients with sepsis in Zhengzhou children's Hospital from January 2012 to December 2015 were selected and divided into sepsis group( n =61),severe sepsis group( n = 17) and septic shock group( n = 11) according to the severity of the disease. The 2 m L venous blood of patients in each group were taken immediately after admission. The serum levels of of C-reactive protein( CRP),tumor necrosis factor-α( TNF-α) and TF,TFPI were detected by enzyme linked immunosorbent assay,the serum level of procalcitonin( PCT) was detected by electrochemiluminescence; and then the relationship between above indexes and pediatric critical illness score( PCIS) was analyzed. Results The serum levels of CRP,TNF-α,PCT and TF in severe sepsis group and septic shock group were significantly higher than those in sepsis group,the TFPI level was significantly lower than that in sepsis group( P <0. 05); the serum level of CRP,TNF-α,PCT and TF in septic shock group were significantly higher than those in severe sepsis group,and the TFPI level was significantly lower than that in severe sepsis group( P < 0. 05). The serum levels of CRP,TNF-α,PCT and TF of sepsis patients were negatively correlated with PCIS( r =-0. 76,-0. 72,-0. 81,-0. 70; P <0. 05); the TFPI level was positively correlated with PCIS( r = 0. 73,P < 0. 05). Conclusion The levels of serum CRP,TNF-α,PCT and TF,TFPI have certain value in evaluating the severity of sepsis. The higher the levels of CRP,TNF-α,PCT and TF,the lower the level of TFPI,the more serious the condition of sepsis patients is.
Objective To investigate the changes and clinical significance of serum levels of inflammatory factors,tissue factor( TF) and tissue factor pathway inhibitor( TFPI) in patients with sepsis. Methods Eighty-nine patients with sepsis in Zhengzhou children's Hospital from January 2012 to December 2015 were selected and divided into sepsis group( n =61),severe sepsis group( n = 17) and septic shock group( n = 11) according to the severity of the disease. The 2 m L venous blood of patients in each group were taken immediately after admission. The serum levels of of C-reactive protein( CRP),tumor necrosis factor-α( TNF-α) and TF,TFPI were detected by enzyme linked immunosorbent assay,the serum level of procalcitonin( PCT) was detected by electrochemiluminescence; and then the relationship between above indexes and pediatric critical illness score( PCIS) was analyzed. Results The serum levels of CRP,TNF-α,PCT and TF in severe sepsis group and septic shock group were significantly higher than those in sepsis group,the TFPI level was significantly lower than that in sepsis group( P <0. 05); the serum level of CRP,TNF-α,PCT and TF in septic shock group were significantly higher than those in severe sepsis group,and the TFPI level was significantly lower than that in severe sepsis group( P < 0. 05). The serum levels of CRP,TNF-α,PCT and TF of sepsis patients were negatively correlated with PCIS( r =-0. 76,-0. 72,-0. 81,-0. 70; P <0. 05); the TFPI level was positively correlated with PCIS( r = 0. 73,P < 0. 05). Conclusion The levels of serum CRP,TNF-α,PCT and TF,TFPI have certain value in evaluating the severity of sepsis. The higher the levels of CRP,TNF-α,PCT and TF,the lower the level of TFPI,the more serious the condition of sepsis patients is.
引文
[1]武宇辉,齐颖,马伟科,等.微小RNA-155和微小RNA-21对脓毒症患儿Toll样受体4表达的影响[J].中华实用儿科临床杂志,2017,32(6):420-424.
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[11]李凡,张伟令,黄东生,等.降钙素原、C反应蛋白在儿童恶性实体瘤并感染及肿瘤进展中的诊断价值[J].中华实用儿科临床杂志,2017,32(10):743-746.
[12]周颖,宋文琪.脓毒血症、细菌性肺炎患儿全血炎症损伤标志物水平变化及意义[J].山东医药,2016,56(20):54-55.
[13]潘伟,刘雪梅.血清炎陛因子在全身型幼年特发陛关节炎与脓毒症患儿鉴别诊断中的价值[J].中华实用儿科临床杂志,2017,32(21):1636-1639.
[14] VAN DER POLL T. Tissue factor as an initiator of coagulation and inflammation in the lung[J]. Crit Care,2008,12(Supple 6):S3.
[15]郑少玲,郭振辉,孙杰,等.组织因子、组织因子途径抑制物对脓毒症凝血异常的影响[J].中国医药导报,2012,34(9):13-15.
[16]王玲玲,郭振辉,姜巧,等.凝血功能异常在脓毒症急性肺损伤发病中的作用[J].广东医学,2012,33(1):37-39.
[17] VAN HINSBERGH V W. Endothelium-role in regulation of coagualtion and inflammation[J]. Semin Immunopathol,2012,34(1):93-106.
[18]闵定宏,余绍青,陈国安,等.中重度烧伤合并脓毒血症患者TFPI、TF、TNF-α的变化[J].实用临床医学,2012,13(12):12-14.
[2]罗淞元,李小霞,王喜梅.脉搏指示连续心排出量监测在脓毒症急性肾损伤治疗中的应用价值[J].新乡医学院学报,2018,35(3):231-234.
[3]孙杭,张宪伟,潘伟,等.补体消耗与脓毒症患儿病情严重程度的相关性[J].中华实用儿科临床杂志,2017,32(6):425-429.
[4] ROBINS R S,LEMARIE C A,LAURANCE S,et al. Vascular Gas6contributes to thrombogenenis and promotes tissue factor upregulation after vessel injury in mice[J]. Blood,2013,121(4):692-699.
[5]卢幼然,狄浩然,丁军颖,等.脓毒症免疫失衡机制及中医治疗[J].世界中医药,2018,13(9):2362-2366.
[6]陈隆望,赵光举,连洁,等.生长停滞特异性蛋白6对脓毒症小鼠凝血功能的影响[J].中华急救医学杂志,2015,24(12):1373-1378.
[7]钱素云,刘娟,郑明琼. 2008版儿童严重脓毒症与脓毒性休克治疗指南解读[J].中华儿科杂志,2009,47(5):349-351.
[8]肖子辉,冯宇鹏,肖献忠. HSF1对内毒素血症小鼠血小板与白细胞相互作用和组织因子表达的影响[J].中国病理生理杂志,2015,10:1820.
[9]许焕胜.监测血清IL-6、CRP及PCT水平在新生儿脓毒血症中的临床应用价值[J].国际检验医学杂志,2016,37(12):1704-1706.
[10]胡方启,程贤高,丁丹,等.儿童脓毒症血培养结果与血清降钙素原关系分析[J].临床儿科杂志,2015,33(4):326-329.
[11]李凡,张伟令,黄东生,等.降钙素原、C反应蛋白在儿童恶性实体瘤并感染及肿瘤进展中的诊断价值[J].中华实用儿科临床杂志,2017,32(10):743-746.
[12]周颖,宋文琪.脓毒血症、细菌性肺炎患儿全血炎症损伤标志物水平变化及意义[J].山东医药,2016,56(20):54-55.
[13]潘伟,刘雪梅.血清炎陛因子在全身型幼年特发陛关节炎与脓毒症患儿鉴别诊断中的价值[J].中华实用儿科临床杂志,2017,32(21):1636-1639.
[14] VAN DER POLL T. Tissue factor as an initiator of coagulation and inflammation in the lung[J]. Crit Care,2008,12(Supple 6):S3.
[15]郑少玲,郭振辉,孙杰,等.组织因子、组织因子途径抑制物对脓毒症凝血异常的影响[J].中国医药导报,2012,34(9):13-15.
[16]王玲玲,郭振辉,姜巧,等.凝血功能异常在脓毒症急性肺损伤发病中的作用[J].广东医学,2012,33(1):37-39.
[17] VAN HINSBERGH V W. Endothelium-role in regulation of coagualtion and inflammation[J]. Semin Immunopathol,2012,34(1):93-106.
[18]闵定宏,余绍青,陈国安,等.中重度烧伤合并脓毒血症患者TFPI、TF、TNF-α的变化[J].实用临床医学,2012,13(12):12-14.