脓毒症合并弥漫性血管内凝血患者血清金属蛋白酶组织抑制剂水平及诊断价值.docVIP

脓毒症合并弥漫性血管内凝血患者血清金属蛋白酶组织抑制剂水平及诊断价值 　　【摘要】目的 检测脓毒症及合并弥漫性血管内凝血（DIC）患者血清金属蛋白酶组织抑制剂（tissue inhibitor of metalloproteinase， TIMP）水平，并判断其对脓毒症患者发展成为DIC的预测诊断价值。方法 取60名患者，其中严重脓毒症患者28例（SS组），脓毒症合并DIC患者12例（SSD组），同期门诊体检者20例为对照组，收集临床及实验室参数，计算APACHEⅡ评分和DIC评分，采用酶联免疫吸附（ELISA）方法检测血清TIMP-1和TIMP-2的水平。结果 SS组患者血清TIMP-1水平（723.74±96.27）较对照组（574.24±79.99）明显升高（P0.05），TIMP-2水平（68.08±14.87）较对照组（89.99±18.45）明显降低（P0.05）。SSD组患者血清TIMP-1水平（907.56±200.20）则较SS组升高明显（P0.05），而TIMP-2水平（44.84±22.13）也较SS组降低更明显（P0.05）。相关分析显示TIMP-1主要与纤维蛋白原（FIB）呈负相关，差异具有统计学意义（P0.05），而与D-二聚体呈正相关，差异具有统计学意义（P0.05）；血清TIMP-2则与血小板计数（PLT）、降钙素原（PCT）、DIC评分呈负相关，差异具有统计学意义（P0.05）。ROC曲线图显示TIMP-1/TIMP-2的AUC=0.896， 95%CI：0.843～0.950（P0.05），较TIMP-1或TIMP-2的AUC更高。结论 脓毒症合并DIC患者的血清TIMP-1水平明显升高，主要影响纤溶系统；TIMP-2水平明显下降，主要影响血小板功能；TIMP-1/TIMP-2对脓毒症合并DIC的发生具有诊断价值。 　　【关键词】脓毒症；弥漫性血管内凝血；金属蛋白酶组织抑制剂 　　Diagnostic value of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intravascular coagulation SONG Jing-chun， HU Dun-zhong，WANG Tao，Chen Zi-li， LIN Zhao-fen. Emergency Department， Changzheng Hospital，The Second Military Medical University，Shanghai 200003，China 　　Corresponding author：LIN Zhao-fen， Email：linzhaofen@ 　　【Abstract】Objective To examine the levels of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intra-vascular coagulation（DIC） and evaluate its diagnostic value in severe sepsis with DIC. Methods Sixty patients were divided into 3 groups， namely severe sepsis group （SS group， n=28）， severe sepsis with DIC group（SSD group， n=12） and normal group（n=20）. Clinical data including APACHEⅡ score and DIC score of these patients were collected. Serum levels of TIMP-1 and TIMP-2 of these patients were measured by using ELISA. Results The patients of SS group had higher levels of TIMP-1（723.74±96.27）and lower levels of TIMP-2（68.08±14.87） than healthy control subjects（TIMP-1：574.24±79.99，TIMP-2：89.99±18.45）（P0.05）. The patients of SSD group had higher levels of TIMP-1（907.56±200.2