血清肝素结合蛋白在脓毒症休克中预测作用.docVIP

血清肝素结合蛋白在脓毒症休克中预测作用 　　【摘要】目的 探讨导致血管渗漏的细胞因子肝素结合蛋白（hepaRin-binding pRotein，HBP）的血清水平在脓毒症及脓毒症休克患者的变化及其对休克的发生和死亡率的早期预测作用。方法 本前瞻性调查研究共纳入2011年8月至2012年7月期间同济大学附属东方医院中心ICU住院符合脓毒症诊断标准患者82例，根据是否存在休克分为脓毒症休克组（A组，39例）和脓毒症非休克组（B组，43例）；另纳入非脓毒症休克患者30例（C组）和非脓毒症无休克组患者（D组）35例作为对照。收集患者入院24 h内动脉血，留取血清ELISA法检测HBP水平，电极法检测乳酸水平，并进行APACHEⅡ评分，两组之间比较根据方差齐性进行t或t’ 检验；建立ROC曲线并计算曲线下面积以分析各指标对脓毒症休克发生及患者病死率的预测价值。结果 脓毒症患者与非脓毒症无休克的患者比较时，A组及B组患者的HBP水平相对于D组均明显升高（P 　　【关键词】肝素结合蛋白；乳酸；APACHEⅡ评分；脓毒症；休克 　　The pRedictive value of seRum hepaRin-binding pRotein level duRing the eaRly stage of septic shock Liu Yang， Ma Shaolin， Wang Xuebin. Intensive CaRe Unit， Shanghai EasteRn Hospital， Shanghai 200120， China 　　CoRResponding authoR： Ma Shaolin， Email： m_slin@sina，com 　　【AbstRact】Objective To study the vaRiation and pRognostic value of seRum hepaRin-binding pRotein （HBP）， a potent induceR of vasculaR leakage in septic shock.Methods A total of 82 sepsis patients admitted to centRal ICU fRom August 2011 to July 2012 weRe enRolled in the pRospective study. Eighty-two sepsis patients weRe divided into septic shock gRoup （gRoup A， n=39） and sepsis without shock gRoup （gRoup B， n=43）. At the same time， anotheR 30 shock patients without sepsis weRe enRolled as gRoup C and 35 patients without sepsis and shock weRe enRolled as gRoup D. Blood samples obtained within 24 houRs afteR enRollment， and the concentRations of HBP weRe measuRed by ELISA and lactate by electRode method. CompaRisons of HBP， lactate and APACHEⅡ scoRe between gRoups weRe caRRied out by Student s t test， and the eaRly pRognostic value in septic shock and moRtality was studied by ReceiveR opeRating chaRacteRistic （ROC） cuRve.Results Patients in gRoup A （t=3，862，P 　　【Key woRds】HepaRin-binding pRotein； Lactate； APACHEⅡ scoRe； Sepsis； Shock 　　脓毒症是重症监护病房死亡的首要病因，各种原因导致的脓毒症患者病死率达到30%～50%[1]。毛细血管渗漏导致血管内液体渗漏至组织间隙，有效循环血量减少，这可能是脓毒症休克尤其休克早期时最主要的病理机制。肝素结合蛋白（hepaRin-binding pRotein，HBP）是一种多功能的炎症介质，主要存在于中性粒细胞的分泌颗粒和嗜天青颗粒中。近期研究发现在HBP血管通透性增加情况下增加，认为其可能参与了脓毒症时休克的病理过