中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
8期
478-481
,共4页
武晓灵%喻莉%龙鼎%杨军辉%张远超%耿峰
武曉靈%喻莉%龍鼎%楊軍輝%張遠超%耿峰
무효령%유리%룡정%양군휘%장원초%경봉
全身炎症反应综合征}尿激酶型纤溶酶原激活物%尿激酶型纤溶酶原激活物受体
全身炎癥反應綜閤徵}尿激酶型纖溶酶原激活物%尿激酶型纖溶酶原激活物受體
전신염증반응종합정}뇨격매형섬용매원격활물%뇨격매형섬용매원격활물수체
Systemic inflammatory response syndrome%Urokinase type plasminogen activator%Urokinase type plasminogen activator receptor
目的 观察全身炎症反应综合征(SIRS)患者血浆尿激酶型纤溶酶原激活物(uPA)及其特异性受体(uPAR)的动态变化以及对预后的影响.方法 采用前瞻性病例对照研究设计方法,将85例住院患者按SIRS诊断标准分为SIRS组(50例)和非SlRS组(35例);SIRS组再按病情分为单纯SIRS组(26例)和合并多器官功能障碍综合征(MODS)组(24例),按预后分为生存组(35例)和死亡组(15例);另选择同期30例健康体检者作为对照.非SIRS组于入院当日,SIRS组于发生SIRS后的1、3、5、7 d,健康对照组于体检时采集空腹静脉血2 ml,用双抗体夹心酶联免疫吸附法(ELISA)测定血浆uPA和uPAR含量,并分析SIRS患者血浆uPAR含量与急性生理学与慢性健康状况评分系统I(APACHE I)评分的相关性.结果 单纯SIRS组、合并MODS组患者血浆uPA和uPAR含量均较非SIRS组和健康对照组显著升高[uPA(μg/L):1.208±0.264、1.120±0.276比0.744±0.190、0.782±0.257;uPAR(μg/L):3.704±1.018、4.970±1.284比1.892±0.476、1.823±0.797,均P＜0.01],且合并MODS组uPAR含量明显高于单纯SIRS组(P＜0.01).与生存组比较,死亡组5 d、7 d血浆uPA含量(μg/L)明显升高(5 d:1.177±0.185比0.856±0.223,7 d:1.377±0.185比0.836±0.223,均P＜0.01),1、3、5、7 d血浆uPAR含量(μg/L)显著增高(1 d:5.301±1.410比3.888±1.015,3 d:4.017±0.898比2.994±0.638,5 d:5.032±1.238比2.536±1.017,7 d:5.232±1.238比3.536±1.017,均P＜0.01).SIRS患者血浆uPAR含量与APACHE I评分呈显著正相关(r=0.640,P＜0.O1).结论 SIRS患者存在凝血功能障碍,血浆uPA、uPAR含量显著增高,uPAR含量的升高提示预后不良.
目的 觀察全身炎癥反應綜閤徵(SIRS)患者血漿尿激酶型纖溶酶原激活物(uPA)及其特異性受體(uPAR)的動態變化以及對預後的影響.方法 採用前瞻性病例對照研究設計方法,將85例住院患者按SIRS診斷標準分為SIRS組(50例)和非SlRS組(35例);SIRS組再按病情分為單純SIRS組(26例)和閤併多器官功能障礙綜閤徵(MODS)組(24例),按預後分為生存組(35例)和死亡組(15例);另選擇同期30例健康體檢者作為對照.非SIRS組于入院噹日,SIRS組于髮生SIRS後的1、3、5、7 d,健康對照組于體檢時採集空腹靜脈血2 ml,用雙抗體夾心酶聯免疫吸附法(ELISA)測定血漿uPA和uPAR含量,併分析SIRS患者血漿uPAR含量與急性生理學與慢性健康狀況評分繫統I(APACHE I)評分的相關性.結果 單純SIRS組、閤併MODS組患者血漿uPA和uPAR含量均較非SIRS組和健康對照組顯著升高[uPA(μg/L):1.208±0.264、1.120±0.276比0.744±0.190、0.782±0.257;uPAR(μg/L):3.704±1.018、4.970±1.284比1.892±0.476、1.823±0.797,均P＜0.01],且閤併MODS組uPAR含量明顯高于單純SIRS組(P＜0.01).與生存組比較,死亡組5 d、7 d血漿uPA含量(μg/L)明顯升高(5 d:1.177±0.185比0.856±0.223,7 d:1.377±0.185比0.836±0.223,均P＜0.01),1、3、5、7 d血漿uPAR含量(μg/L)顯著增高(1 d:5.301±1.410比3.888±1.015,3 d:4.017±0.898比2.994±0.638,5 d:5.032±1.238比2.536±1.017,7 d:5.232±1.238比3.536±1.017,均P＜0.01).SIRS患者血漿uPAR含量與APACHE I評分呈顯著正相關(r=0.640,P＜0.O1).結論 SIRS患者存在凝血功能障礙,血漿uPA、uPAR含量顯著增高,uPAR含量的升高提示預後不良.
목적 관찰전신염증반응종합정(SIRS)환자혈장뇨격매형섬용매원격활물(uPA)급기특이성수체(uPAR)적동태변화이급대예후적영향.방법 채용전첨성병례대조연구설계방법,장85례주원환자안SIRS진단표준분위SIRS조(50례)화비SlRS조(35례);SIRS조재안병정분위단순SIRS조(26례)화합병다기관공능장애종합정(MODS)조(24례),안예후분위생존조(35례)화사망조(15례);령선택동기30례건강체검자작위대조.비SIRS조우입원당일,SIRS조우발생SIRS후적1、3、5、7 d,건강대조조우체검시채집공복정맥혈2 ml,용쌍항체협심매련면역흡부법(ELISA)측정혈장uPA화uPAR함량,병분석SIRS환자혈장uPAR함량여급성생이학여만성건강상황평분계통I(APACHE I)평분적상관성.결과 단순SIRS조、합병MODS조환자혈장uPA화uPAR함량균교비SIRS조화건강대조조현저승고[uPA(μg/L):1.208±0.264、1.120±0.276비0.744±0.190、0.782±0.257;uPAR(μg/L):3.704±1.018、4.970±1.284비1.892±0.476、1.823±0.797,균P＜0.01],차합병MODS조uPAR함량명현고우단순SIRS조(P＜0.01).여생존조비교,사망조5 d、7 d혈장uPA함량(μg/L)명현승고(5 d:1.177±0.185비0.856±0.223,7 d:1.377±0.185비0.836±0.223,균P＜0.01),1、3、5、7 d혈장uPAR함량(μg/L)현저증고(1 d:5.301±1.410비3.888±1.015,3 d:4.017±0.898비2.994±0.638,5 d:5.032±1.238비2.536±1.017,7 d:5.232±1.238비3.536±1.017,균P＜0.01).SIRS환자혈장uPAR함량여APACHE I평분정현저정상관(r=0.640,P＜0.O1).결론 SIRS환자존재응혈공능장애,혈장uPA、uPAR함량현저증고,uPAR함량적승고제시예후불량.
Objective To study the dynamic changes in plasma levels of urokinase type plasminogen activator (uPA) and urokinase type plasminogen activator receptor (uPAR) and their influence on prognosis in patients with systemic inflammatory response syndrome (SIRS). Methods In this study, a prospective clinical case-control study was adopted. Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS: SIRS patients (n= 50) and non-SIRS patients (n= 35). SIRS patients were again divided into SIRS group (n=26) and SIRS complicated by multiple organ dysfunction syndrome (MODS)group (n= 24) by their severity, and survival group (n = 35) and non-survival group (n = 15) by their outcome. The control group comprised of 30 healthy blood donors. Venous blood samples of about 2 ml were collected at the time when non-SIRS patients were admitted, and blood samples were collected in SIRS patients on 1,3, 5 and 7 days when SIRS was diagnosed, and in the healthy control group blood samples were collected when they visited the General Health Check-up Division at our hospital. Plasma levels of uPA and uPAR were measured by enzyme-linked immunosorbent assay (ELISA), and relationship between plasma level of uPAR and acute physiology and chronic health evaluation I (APACHE I ) score was analyzed using Pearson correlation. Results The plasma levels of uPA and uPAR in patients of SIRS and MODS were obviously higher compared with non-SIRS and healthy controls[uPA (μg/L): 1. 208± 0. 264, 1. 120±0. 276vs. 0.744±0.190, 0.782±0.257; uPAR (tμg/L): 3.704±1.018, 4.970±1.284 vs. 1.892±0.476,1. 823± 0. 797, all P＜0.01]. The plasma level of uPAR in MODS group was obviously higher than that of SIRS group (P＜0.01). The plasma level of uPA (μg/L) in non-survival group was markedly elevated on 5 days and 7 days compared to survival group (5 days: 1. 177±0. 185 vs. 0. 856±0. 223, 7 days: 1. 377±0. 185 vs. 0. 836±0. 223, both P＜0. 01). The plasma level of uPAR (μg/L) in patients of non-survival group was obviously higher compared with survival group on 1, 3, 5 and 7 days (1 day: 5. 301 ±1. 410 vs.3. 888±1. 015, 3 days: 4. 017±0. 898 vs. 2. 994±0. 638, 5 days: 5. 032±1. 238 vs. 2. 536±1. 017, 7 days:5. 232 ± 1. 238 vs. 3. 536 ± 1. 017, all P ＜ 0. 01). Correlation analysis showed that there was positive correlation between uPAR level and APACHE I score (r=0. 640, P＜0. 01). Conclusion Coagulopathy is present in SIRS patients, the plasma levels of uPA and uPAR are high in patients with SIRS, and the increase of uPAR in patients with SIRS indicates a poor prognosis.
