血小板活化相关因子和血栓前体蛋白在严重脓毒症中的表达
혈소판활화상관인자화혈전전체단백재엄중농독증중적표체
Expression and clinical significance of platelet activating factor (PAC-1), CD629P and thrombus precursor protein (TpP) in severe sepsis
  • 万方数据
    中华急诊医学杂志 중화급진의학잡지
    CHINESE JOURNAL OF EMERGENCY MEDICINE
    2008年 10期 1080-1084 ,共5页

    耿平%张劲松%夏仲芳%顾健%徐敏%徐继扬%谈定玉%解松刚%沈连军%马爱闻

    경평%장경송%하중방%고건%서민%서계양%담정옥%해송강%침련군%마애문

    血小板膜糖蛋白(GP)Ⅱb/Ⅲa复合物纤维蛋白原受体%血小板颗粒膜糖蛋白140%血栓前体蛋白%脓毒症%血小板活化%高凝状态 血小闆膜糖蛋白(GP)Ⅱb/Ⅲa複閤物纖維蛋白原受體%血小闆顆粒膜糖蛋白140%血栓前體蛋白%膿毒癥%血小闆活化%高凝狀態
    혈소판막당단백(GP)Ⅱb/Ⅲa복합물섬유단백원수체%혈소판과립막당단백140%혈전전체단백%농독증%혈소판활화%고응상태
    PAC-1%CD62P%TpP%Sepsis%Platelet activation%Hypercoagulability
    目的 探讨血小板活化相关因子(PAC-1、CD62P)和血栓前体蛋白(TpP)在严蘑脓毒症患者中的表达及其临床意义. 方法 前瞻性地选取2007年4月至2008年3月江苏省苏北人民医院急诊监护病房(EICU)收治的符合严重脓毒症诊断标准的患者入选严重脓毒症组(Ⅲ组).按照严重脓毒症治疗指南进行治疗,并根据28 d内是否存活分为生存亚组和死亡亚组,存在感染但未发生脓毒症同期患者设为一般感染组(Ⅱ组),同期门诊体检者或健康自愿者设为正常对照组(Ⅰ组).病例的选取均遵循随机的原则,三组的年龄、性别具有可比性;急性脑梗死、急性冠脉综合征、严重糖尿病和高脂血症者、恶性肿瘤、白血病、原发肝、肾、造血系统疾病者.长期卧床者、孕妇、近期使用过激素和免疫抑制剂者均除外.Ⅰ组和Ⅱ组均在入院第1天清晨空腹,Ⅲ组在入院第1、3,5天清晨空腹取外周静脉血,用酶联免疫吸附测定法(ELISA法)测定血栓前体蛋白(TpP),流式细胞术测定血小板膜糖蛋白(GP)Ⅱb/Ⅲ a复合物纤维蛋白原受体(PAC-1)、血小板颗粒膜糖蛋白140(CD62P),并对Ⅲ组进行Mar-shall评分.应用SPSS 12.0软件包处理数据,多组均数间比较采用方差分析,方差齐性检验采用Levene's法,方差齐性时采用LSD法,相关分析采用Bivariate法,以P<0.05为差异具有统计学意义. 结果 共有20例纳入Ⅰ组,20例纳入Ⅱ组,30例纳入Ⅲ组,其中生存亚组19例,死亡亚组11例.入院第1天,PAC-1、CD62P、TpP在Ⅰ组与Ⅱ组之间的表达差异无统计学意义(P>0.05),但Ⅰ组与Ⅲ组、Ⅱ组与Ⅲ组之间均差异具有统计学意义(P<0.05);PAC-1、CD62D、TpP在生存亚组的表达均随着病程显著下降而趋于正常,而在死亡亚组仍持续保持高值甚至显著升高,第1天时CD62P、TpP在亚组的表达差异无统计学意义(P>0.05),但在第3天时差异具有统计学意义,分别为(2.89±1.48)%vs.(5.04±2.57)%,P<0.01和(5.24±2.22)mg/L vs.(9.20±1.93)mg/L(P<0.01);而PAC-1在入院第1天亚组中的表达差异具有统计学意义(P<0.01),为(3.15±0.42)%vs.(5.30±0.48)%.两组的Marshall评分也呈类似变化,相关性分析显示:PAC-1、CD62P、TpP与Marshall评分呈明显正相关. 结论 严重脓毒症的早期就存在血小板活化和微血栓形成,两者共同参与了早期的高凝状态,在病情的发生发展过程中扮演了重要角色.动态监测CD62P和TpP有助于判断病情和预后,PAC-1具有危险分层效应,早期高表达者预后差,可尝试作为严重脓毒症的独立预警指标.
    목적 탐토혈소판활화상관인자(PAC-1、CD62P)화혈전전체단백(TpP)재엄마농독증환자중적표체급기림상의의. 방법 전첨성지선취2007년4월지2008년3월강소성소북인민의원급진감호병방(EICU)수치적부합엄중농독증진단표준적환자입선엄중농독증조(Ⅲ조).안조엄중농독증치료지남진행치료,병근거28 d내시부존활분위생존아조화사망아조,존재감염단미발생농독증동기환자설위일반감염조(Ⅱ조),동기문진체검자혹건강자원자설위정상대조조(Ⅰ조).병례적선취균준순수궤적원칙,삼조적년령、성별구유가비성;급성뇌경사、급성관맥종합정、엄중당뇨병화고지혈증자、악성종류、백혈병、원발간、신、조혈계통질병자.장기와상자、잉부、근기사용과격소화면역억제제자균제외.Ⅰ조화Ⅱ조균재입원제1천청신공복,Ⅲ조재입원제1、3,5천청신공복취외주정맥혈,용매련면역흡부측정법(ELISA법)측정혈전전체단백(TpP),류식세포술측정혈소판막당단백(GP)Ⅱb/Ⅲ a복합물섬유단백원수체(PAC-1)、혈소판과립막당단백140(CD62P),병대Ⅲ조진행Mar-shall평분.응용SPSS 12.0연건포처리수거,다조균수간비교채용방차분석,방차제성검험채용Levene's법,방차제성시채용LSD법,상관분석채용Bivariate법,이P<0.05위차이구유통계학의의. 결과 공유20례납입Ⅰ조,20례납입Ⅱ조,30례납입Ⅲ조,기중생존아조19례,사망아조11례.입원제1천,PAC-1、CD62P、TpP재Ⅰ조여Ⅱ조지간적표체차이무통계학의의(P>0.05),단Ⅰ조여Ⅲ조、Ⅱ조여Ⅲ조지간균차이구유통계학의의(P<0.05);PAC-1、CD62D、TpP재생존아조적표체균수착병정현저하강이추우정상,이재사망아조잉지속보지고치심지현저승고,제1천시CD62P、TpP재아조적표체차이무통계학의의(P>0.05),단재제3천시차이구유통계학의의,분별위(2.89±1.48)%vs.(5.04±2.57)%,P<0.01화(5.24±2.22)mg/L vs.(9.20±1.93)mg/L(P<0.01);이PAC-1재입원제1천아조중적표체차이구유통계학의의(P<0.01),위(3.15±0.42)%vs.(5.30±0.48)%.량조적Marshall평분야정유사변화,상관성분석현시:PAC-1、CD62P、TpP여Marshall평분정명현정상관. 결론 엄중농독증적조기취존재혈소판활화화미혈전형성,량자공동삼여료조기적고응상태,재병정적발생발전과정중분연료중요각색.동태감측CD62P화TpP유조우판단병정화예후,PAC-1구유위험분층효응,조기고표체자예후차,가상시작위엄중농독증적독립예경지표.
    Objective To investigate the expression and clinical significance of platelet activating factor [PAC]-1, CD62P and TPP hi severe sepsis. Method Patients with severe sepsis who were admitted into the EICU of Subei People's Hospital from April 2007 to March 2008 were included. Patients with severe sepsis (Group Ⅲ)were treated according to the treatment guidelines for severe sepsis, and were divided, according to their clinical records, into those who survived and those who died within 28 days of admission. Patients admitted during the same period with symptoms of infection but without severe sepsis were included as the General Infected Group (Group Ⅱ). A Control Group (Group Ⅰ) comprised patients who visited the hospital over the same period for physical examination or the healthy volunteers. The group members were all included randomly, and the gender and sex of patients in all three groups were similar. Patients with acute brain infarction, acute coronary syndrome,serious diabetes, hyperlipidemia, malignant tumor, leukemia, primary liver, renal and hematopoietic system dis-eases,long-term bedridden patients, pregnant women, and patients taking hormone treatment or hranunosuppres-sants were excluded from the study. Morning venous blood was collected and ELISA and Flow Cytometry performed on the fwst day of admission for Groups Ⅰ- and Ⅱ, and on the first, third and fifth day after admission for Group Ⅲ, to determine the TpP,PAC-1 and CD62P respectively; and the Marshall score was determined. Data were ana-lyzed by SPSS 12.0 software. For continuous variables, comparisons among groups were analyzed by ANOVA.Levene's and LSD test were applied to assess homogeneity. Bivariate test is applied to Correlation Analysis. P<0.05 was regarded as a statistically significant difference. Results There were a total of 20 patients each in GroupⅠ-and GroupⅡ, and 30 in Group Ⅲ; of these, 19 were classed as survivors and 11 died during the 28-day peri-od. On the first day of admission, there were no significant differences in PAC-1, CD62P or TpP expression between Groups Ⅰ- and Ⅱ(P>0.05); however, Group Ⅲ was significantly different compared with both Group Ⅰ and Group Ⅱ (both:P<0.05). The expression of PAC-1, CD62P and TpP tended to decline in the survivor group,and became normal with the treatment process, while the expression of PAC-1 ,CD62P and TpP in the patients who died remained high, and even increased significantly over time. On the first day, the expression of CD62P and TpP in the patients who survived and in those who died was not significantly different (P>0.05); on the third day,however, a significant difference appeared with values of (2.89±1.48) % vs. (5.04±2.57) % (P<0.01) for CD62P, and (5.24±2.22) mg/L vs. (9.20±1.93) mg/L (P<0.01) for TpP. The expression of PAC-1 was significantly different between the two subgroups on the first day, with values of (3.15±0.42)% vs. (5.30±.48)% (P<0.01). The Marshall score of the two groups showed similar changes. Correlation analysis showed that PAC-1, CD62P and TpP were significantly correlated with the Marshall score. Conclusions Platelet activation and microthrombosis existing in the early stage of severe sepsis work together in the early hypercoagulable state.They both play important roles in disease development and progression. The dynamic detection of CD62P and TpP is beneficial to the diagnosis and prognosis of severe sepsis.PAC-1 appears to hold a risk stratification effect, as pa-tients with high expression of PAC-1 in the early stage show poor prognosis. Therefore, PAC-1 could be used as a marker of severe sepsis and poor prognsis.
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