脓毒症患儿内皮细胞损伤标记物水平变化及其与严重程度的关系
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摘要
目的探讨脓毒症患儿内皮细胞损伤标记物水平变化,以及与脓毒症严重程度之间的关系。方法选择0~14岁急性脓毒症及脓毒性休克小儿各30例为研究对象,对照组为非脓血症对象60例,入院后第1,3,7天对内皮细胞损伤相关的标记物进行检测,并比较两组对象之间标记物水平。结果脓毒血症患者观察循环内皮祖细胞(cEPCs)、内皮细胞特异性分子-1(ESM-1)、可溶性血栓调节蛋白(sTM)和可溶性E-选择素(sE-选择素)的浓度均明显高于正常对照组,差异有统计学意义(P<0.01),且此四种标记物水平在病程的发展早期中均呈逐渐上升,发病第7天的cEPCs、ESM-1、sTM和sE-选择素水平明显高于第1天(P<0.05)。严重脓毒症和/或脓毒性休克组患者在早期cEPCs和ESM-1的水平明显高于脓毒血症组,差异均有统计学意义(P<0.01),但sTM和sE-选择素的水平在两组患者之间的差异无统计学意义。结论内皮细胞损伤与脓毒血症的发生和发展均显著相关,且cEPCs和ESM-1与脓毒血症严重程度存在显著关联。
Objective To investigate the relationship with the severity of sepsis and detect the changes of endothelial cell damage markers in children with sepsis.Methods Subjects with 0~14years old were recruited from sepsis and septic shock patients in our hospital,from January 2013-2015 September,the study subjects were divided into three groups,endothelial cells damage related markers were detected at the 1st,3rd,7th day,and compared endothelial cell damage markers between the two groups.Results The levels of cEPCs,ESM-1,sTM and Se-selectin in sepsis patients were significantly higher than those in the normal control group,and there were statistical significantly differences(P<0.01).With the progress of disease,the levels of four kinds of markers were raised gradually.The levels of cEPCs,ESM-1,sTM and Se-selectin on the 7th day were higher than those on the 1st day(P<0.05).On the first day,cEPCs and ESM-1level in severe sepsis and/or septic shock group patients were significantly higher than those in the sepsis group,and there were statistical significantly differences(P<0.01),but there were no statistical significantly differences for sTM and Se-selectin levels between the two groups.Conclusion Endothelial cell injury was significantly correlated with the occurrence and development of sepsis,and cEPCs and ESM-1level were associated with severity of sepsis.
Objective To investigate the relationship with the severity of sepsis and detect the changes of endothelial cell damage markers in children with sepsis.Methods Subjects with 0~14years old were recruited from sepsis and septic shock patients in our hospital,from January 2013-2015 September,the study subjects were divided into three groups,endothelial cells damage related markers were detected at the 1st,3rd,7th day,and compared endothelial cell damage markers between the two groups.Results The levels of cEPCs,ESM-1,sTM and Se-selectin in sepsis patients were significantly higher than those in the normal control group,and there were statistical significantly differences(P<0.01).With the progress of disease,the levels of four kinds of markers were raised gradually.The levels of cEPCs,ESM-1,sTM and Se-selectin on the 7th day were higher than those on the 1st day(P<0.05).On the first day,cEPCs and ESM-1level in severe sepsis and/or septic shock group patients were significantly higher than those in the sepsis group,and there were statistical significantly differences(P<0.01),but there were no statistical significantly differences for sTM and Se-selectin levels between the two groups.Conclusion Endothelial cell injury was significantly correlated with the occurrence and development of sepsis,and cEPCs and ESM-1level were associated with severity of sepsis.
引文
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[15]David Béchard,Arnaud,Scherpereel,et al.Human endothelial-cell Specific Molecule-1Binds directly to the integrin CD11a/CD18(LFA-1)and blocks binding to intercellular adhesion molecule-1[J].J Immunol,2001,167:3099-3106.
[2]Vincent JL,Marshall JC,amendys-Silva SA,et al.Assessment of the worldwide burden of critical illness:the Intensive Care Over Nations(ICON)audit[J].Lancet Res Med,2014;2(5):380-386.
[3]Palud A,Parmentier-Decrucq E,Pastre J,et al.Evaluation of endothelial biomarkers as predictors of organ failures in septic shock patients[J].Cytokine,2015,73(2):213-218.
[4]中华医学会儿科学分会急救学组,中华医学会急诊学分会儿科组,中华儿科杂志编辑委员会.儿科感染性休克(脓毒性休克)诊疗推荐方案[J].中华儿科杂志2006,44(8):596-598.
[5]Warren L,Leea W,Conrad L.Endothelial activation,dysfunction and permeability during severe infections[J].Curr Opin Hematol,2011,18:191-196.
[6]Benoít V.Endothelial cell dysfunction in severe sepsis:a role in organ dysfunction[J].Crit Care,2003,7(2):130-138.
[7]Tslotou AG,Sakorafas GH,Anagnostopoulos G,et al.Septic shock:current pathogenetic concepts from a clinical perspective[J].Med Sci Monit,2005,11(3):76-85.
[8]Cribbs SK,Sutcliffe DJ,Taylor WR,et al.Circulating endothelial progenitor cells inversely associate with organ dysfunction in sepsis[J].Intensive Care Med,2012,38(3):429-436.
[9]George J,Goldstein E,Abashidze S,et al.Circulating endothelial progenitor cells in patients with unstable angina:association with systemic inflammation[J].Eur Heart,2004,25(11):1003-1008.
[10]Burnham EL,Taylor WR,Quyyumi AA,et al.Increased circulating endothelial progenitor cells are associated with survival in acute lung injury[J].Am J Respir Crit Care Med,2005,172(9):854-860.
[11]张亮,陈林,黄显凯.多发伤患者血ESM-1的动态变化与脓毒症的关系[J].重庆医学,2007,36(22):2259-2260.
[12]Roldan V,Marin F,BlannA,et al.Soluble E-selectin,interleukin-6and tiss ue factor in two cases of meningococcal septicaemia[J].Blood Coagul Fibrinolysis,2004,15(2):179-182.
[13]Levi M,van der Poll T.Inflammation and coagulation[J].Crit Care Med,2010,38(2Suppl):S26-S34.
[14]Sarrazin S,Adam E,Lyon M,et al.Endocan or endothelial cell specific molecule-1(ESM-1):apotential novel endothelial cell marker and a new target for cancer therapy[J].Biochim Biophys Acta,2006,1765(1):25-37.
[15]David Béchard,Arnaud,Scherpereel,et al.Human endothelial-cell Specific Molecule-1Binds directly to the integrin CD11a/CD18(LFA-1)and blocks binding to intercellular adhesion molecule-1[J].J Immunol,2001,167:3099-3106.