脓毒症患者休克指数与炎症反应、氧化应激反应、靶器官损伤的相关性研究
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摘要
目的:探讨脓毒症患者休克指数与炎症反应、氧化应激反应、靶器官损伤的相关性。方法:收集2013年3月~2016年5月间本院收治的脓毒症患者70例,根据休克指数(SI)分为无休克组(SI<0.5)11例、一般休克组(0.5≤SI≤2)42例、严重休克组(SI>2.0)17例。入院后即刻,检测血清炎症因子、氧化应激指标、肝功能指标的含量。结果:严重休克组、一般休克组患者的血清白介素-1β(IL-1β)、白介素-8(IL-8)、肿瘤坏死因子α(TNF-α)、晚期蛋白氧化产物(AOPPs)、总胆红素(TB)、γ-转肽酶(GGT)、丙氨酸转氨酶(ALT)含量高于无休克组患者,抗炎因子白介素-10(IL-10)、白介素-13(IL-13)、可溶性肿瘤坏死因子Ⅰ型受体(sTNF-RI)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)含量低于无休克组患者;严重休克组患者的血清IL-1β、IL-8、TNF-α、AOPPs、TB、GGT、ALT含量高于一般休克组患者,IL-10、IL-13、sTNF-RI、CAT、GSH-Px、SOD含量低于一般休克组患者。结论:脓毒症患者休克指数越高,炎症反应、氧化应激反应、靶器官损伤越严重,两者呈正相关关系。
Objective:To study the correlation between shock index and inflammation,oxidative stress as well as target organ damage in patients with sepsis.Methods:A total of 70 patients with sepsis treated in our hospital between March 2013 and May 2016 were collected and divided into no shock group(SI<0.5)(n=11),general shock group(0.5≤SI≤2)(n=42)and severe shock group(SI>2.0)(n=17)according to the shock index(SI).Immediately after admission,serum levels of inflammatory factors,oxidative stress indexes and liver function indexes were detected.Results:Serum interleukin-1β(IL-1β),interleukin-8(IL-8),tumor necrosis factorα(TNF-α),catalase(CAT),advanced oxidation protein products(AOPPs),total bilirubin(TB),γ-glutamyl transpeptidase(GGT)and alanine aminotransferase(ALT)levels of severe shock group and general shock group were higher than those of no shock group while anti-inflammatory factors interleukin-10(IL-10),interleukin-13(IL-13),soluble tumor necrosis factor receptorⅠ(sTNF-RI),glutathione peroxidase(GSH-Px)and superoxide dismutase(SOD)levels were lower than those of no shock group;serum IL-1β,IL-8,TNF-α,AOPPs,TB,GGT and ALT levels of se-vere shock group were higher than those of general shock group while IL-10,IL-13,sTNF-RI,CAT,GSH-Px and SOD levels were lower than those of general shock group.Conclusions:The higher the shock index in patients with sepsis,the more severe the inflammation,oxidative stress and target organ damage,and the two are positively correlated.
Objective:To study the correlation between shock index and inflammation,oxidative stress as well as target organ damage in patients with sepsis.Methods:A total of 70 patients with sepsis treated in our hospital between March 2013 and May 2016 were collected and divided into no shock group(SI<0.5)(n=11),general shock group(0.5≤SI≤2)(n=42)and severe shock group(SI>2.0)(n=17)according to the shock index(SI).Immediately after admission,serum levels of inflammatory factors,oxidative stress indexes and liver function indexes were detected.Results:Serum interleukin-1β(IL-1β),interleukin-8(IL-8),tumor necrosis factorα(TNF-α),catalase(CAT),advanced oxidation protein products(AOPPs),total bilirubin(TB),γ-glutamyl transpeptidase(GGT)and alanine aminotransferase(ALT)levels of severe shock group and general shock group were higher than those of no shock group while anti-inflammatory factors interleukin-10(IL-10),interleukin-13(IL-13),soluble tumor necrosis factor receptorⅠ(sTNF-RI),glutathione peroxidase(GSH-Px)and superoxide dismutase(SOD)levels were lower than those of no shock group;serum IL-1β,IL-8,TNF-α,AOPPs,TB,GGT and ALT levels of se-vere shock group were higher than those of general shock group while IL-10,IL-13,sTNF-RI,CAT,GSH-Px and SOD levels were lower than those of general shock group.Conclusions:The higher the shock index in patients with sepsis,the more severe the inflammation,oxidative stress and target organ damage,and the two are positively correlated.
引文
1陈伟,胡志华,陈勉.脓毒症患者血浆中抗AT-Ⅲ水平测定的临床意义[J].海南医学院学报,2015,21(8):1060-1063.
2 Scheer C,Fuchs C,Rehberg S.Biomarkers in severe sepsis and septic shock:Just listen to the heart?[J].Critical Care Medicine,2016,44(4):849-850.
3 李晓明,李腾成,杨飞,等.经皮肾镜取石术中不同灌注压力对术后患者感染状态及肾功能的影响[J].中华医院感染学杂志,2016,26(19):4485-4488.
4 Wira CR,Francis MW,Bhat S,et al.The shock index as a predictor of vasopressor use in emergency department patients with severe sepsis[J].The Western Journal of Emergency Medicine,2014,15(1):60-66.
5 唐昊,刘冬,张画羽,等.三版国际脓毒症诊断标准诊断效能分析[J].解放军医学杂志,2016,41(4):295-298.
6 Park SH,Ha SO,Cho YU,et al.Immature platelet fraction in septic patients:clinical relevance of immature platelet fraction is limited to the sensitive and accurate discrimination of septic patients from non-septic patients,not to the discrimination of sepsis severity[J].Annals of Laboratory Medicine,2016,36(1):1-8.
7 Englert NC,McDermott D.Back to fundamentals:using highand low-fidelity simulation to provide reinforcement of preventative measures for sepsis[J].Critical Care Nursing Quarterly,2016,39(1):14-23.
8 郭志军,訾学荣,王建新,等.CT血管成像评价主动脉夹层转运风险与休克指数的相关性[J].中国医学影像学杂志,2014,22(2),134-137.
9 Lewis SM,Treacher DF,Edgeworth J,et al.Expression of CD11cand EMR2on neutrophils:potential diagnostic biomarkers for sepsis and systemic inflammation[J].Clinical and Experimental Immunology,2015,182(2):184-194.
10 陈婵,李锁北,徐军美,等.microRNAs在脓毒症引起的炎症反应中的调控机制[J].东南大学学报(医学版),2016,35(5):773-778.
11 霍江,李强,于颖群,等.丙泊酚和依托咪酯对脓毒症小鼠炎症反应与氧化应激的影响[J].临床麻醉学杂志,2015,31(12):1221-1224.
12 Kamisoglu K,Haimovich B,Calvano SE,et al.Human metabolic response to systemic inflammation:assessment of the concordance between experimental endotoxemia and clinical cases of sepsis/SIRS[J].Critical Care(London,England),2015,19(1):783.
13 Tsirigotis P,Papanikolaou N,Elefanti A,et al.Treatment of experimental candida sepsis with a janus kinase inhibitor controls inflammation and prolongs survival[J].Antimicrobial Agents and Chemotherapy,2015,59(12):7367-7373.
14 刘典勋.富含n-3多不饱和脂肪酸对盲肠结扎穿孔致脓毒症大鼠靶器官功能及免疫炎症反应的调节作用[J].海南医学院学报,2016,22(2):122-125.
15 白静,张文丽,张军伟,等.脓毒症大鼠心肌氧化应激损伤及心肌细胞超微结构变化[J].细胞与分子免疫学杂志,2015,31(5):634-637.
16 Zeng M,He W,Li L,et al.Ghrelin attenuates sepsis-associated acute lung injury oxidative stress in rats[J].Inflammation,2015,38(2):683-690.
17 Vieira AA,Michels M,Florentino D,et al.Obesity promotes oxidative stress and exacerbates sepsis-induced brain damage[J].Current Neurovascular Research,2015,12(2):147-154.
18 吴吟,任建安.氧化应激在脓毒症导致的肝损伤中的作用[J].中国实用外科杂志,2014,34(2):187-190.
19 栾正刚,马晓春.围手术期肝功能障碍类型及处理[J].中国实用外科杂志,2014,34(2):123-136.
20 蒋华,周珉,吕海,等.犀角地黄汤对脓毒症大鼠肝功能及肝组织病理的影响[J].中医杂志,2016,57(8):696-699.
2 Scheer C,Fuchs C,Rehberg S.Biomarkers in severe sepsis and septic shock:Just listen to the heart?[J].Critical Care Medicine,2016,44(4):849-850.
3 李晓明,李腾成,杨飞,等.经皮肾镜取石术中不同灌注压力对术后患者感染状态及肾功能的影响[J].中华医院感染学杂志,2016,26(19):4485-4488.
4 Wira CR,Francis MW,Bhat S,et al.The shock index as a predictor of vasopressor use in emergency department patients with severe sepsis[J].The Western Journal of Emergency Medicine,2014,15(1):60-66.
5 唐昊,刘冬,张画羽,等.三版国际脓毒症诊断标准诊断效能分析[J].解放军医学杂志,2016,41(4):295-298.
6 Park SH,Ha SO,Cho YU,et al.Immature platelet fraction in septic patients:clinical relevance of immature platelet fraction is limited to the sensitive and accurate discrimination of septic patients from non-septic patients,not to the discrimination of sepsis severity[J].Annals of Laboratory Medicine,2016,36(1):1-8.
7 Englert NC,McDermott D.Back to fundamentals:using highand low-fidelity simulation to provide reinforcement of preventative measures for sepsis[J].Critical Care Nursing Quarterly,2016,39(1):14-23.
8 郭志军,訾学荣,王建新,等.CT血管成像评价主动脉夹层转运风险与休克指数的相关性[J].中国医学影像学杂志,2014,22(2),134-137.
9 Lewis SM,Treacher DF,Edgeworth J,et al.Expression of CD11cand EMR2on neutrophils:potential diagnostic biomarkers for sepsis and systemic inflammation[J].Clinical and Experimental Immunology,2015,182(2):184-194.
10 陈婵,李锁北,徐军美,等.microRNAs在脓毒症引起的炎症反应中的调控机制[J].东南大学学报(医学版),2016,35(5):773-778.
11 霍江,李强,于颖群,等.丙泊酚和依托咪酯对脓毒症小鼠炎症反应与氧化应激的影响[J].临床麻醉学杂志,2015,31(12):1221-1224.
12 Kamisoglu K,Haimovich B,Calvano SE,et al.Human metabolic response to systemic inflammation:assessment of the concordance between experimental endotoxemia and clinical cases of sepsis/SIRS[J].Critical Care(London,England),2015,19(1):783.
13 Tsirigotis P,Papanikolaou N,Elefanti A,et al.Treatment of experimental candida sepsis with a janus kinase inhibitor controls inflammation and prolongs survival[J].Antimicrobial Agents and Chemotherapy,2015,59(12):7367-7373.
14 刘典勋.富含n-3多不饱和脂肪酸对盲肠结扎穿孔致脓毒症大鼠靶器官功能及免疫炎症反应的调节作用[J].海南医学院学报,2016,22(2):122-125.
15 白静,张文丽,张军伟,等.脓毒症大鼠心肌氧化应激损伤及心肌细胞超微结构变化[J].细胞与分子免疫学杂志,2015,31(5):634-637.
16 Zeng M,He W,Li L,et al.Ghrelin attenuates sepsis-associated acute lung injury oxidative stress in rats[J].Inflammation,2015,38(2):683-690.
17 Vieira AA,Michels M,Florentino D,et al.Obesity promotes oxidative stress and exacerbates sepsis-induced brain damage[J].Current Neurovascular Research,2015,12(2):147-154.
18 吴吟,任建安.氧化应激在脓毒症导致的肝损伤中的作用[J].中国实用外科杂志,2014,34(2):187-190.
19 栾正刚,马晓春.围手术期肝功能障碍类型及处理[J].中国实用外科杂志,2014,34(2):123-136.
20 蒋华,周珉,吕海,等.犀角地黄汤对脓毒症大鼠肝功能及肝组织病理的影响[J].中医杂志,2016,57(8):696-699.