目的 探讨血浆总脂联素(APN)及高分子脂联素(HAP)在脓毒症中的变化规律、与感染的关系以及对疾病预后的提示意义.方法 采用前瞻性研究方法,选择2011年6月至11月本院重症监护病房(ICU)脓毒症患者80例,采用酶联免疫吸附试验(ELISA)检测入ICU 2 h、2d、6d血浆APN水平(总APN及HAP),并测定降钙素原(PCT)、内毒素水平,进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、简化急性生理学评分Ⅱ(SAPSⅡ)评分,计算胰岛素抵抗指数;并以20例健康志愿者及21例全身炎症反应综合征(SIRS)患者作为对照.结果 脓毒症患者入ICU 2 h血浆总APN(mg/L)及HAP(mg/L)水平较健康对照组和SIRS组显著下降[总APN:2.87 (2.28,3.89)比6.48±1.53、3.72 (2.67,4.59),HAP:2.64( 2.07,3.75)比5.12±1.98、3.33(2.23,4.24),P＜0.05或P＜0.01],且与PCT水平呈显著负相关(r1=-0.559,r2=-0.530,均P＜0.01),与内毒素水平均无相关性;通过偏相关分析校正危重患者胰岛素抵抗对APN水平造成的影响后发现,APN与PCT及内毒素的相关性与未校正前基本相同.一般脓毒症、严重感染、感染性休克组间APN差异存在统计学意义,且与APACHEⅡ、SOFA、SAPSⅡ评分呈显著负相关(总APN r值分别为-0.868、-0.766、-0.725,HAP r值分别为-0.859、-0.715、-0.692,均P＜0.01);脓毒症存活患者(41例)血浆总APN和HAP水平随疾病治愈逐渐升高(x21=34.520,x22=27.802,均P＜0.01),死亡患者(7例)总APN、HAP水平则呈下降趋势(x21=3.938,x22=3.938,均P＞0.05);入ICU 2 h总APN、HAP与ICU住院时间(r1=-0.275,P1=0.014;r2=-0.299,P2=0.007)、机械通气时间(r1=-0.393,r2=-0.519,均P＜0.01)呈显著负相关.结论 血浆总APN及HAP在脓毒症患者中明显下降,与PCT水平呈负相关,对感染有诊断意义,且与脓毒症严重程度有关,可提示预后.
目的 探討血漿總脂聯素(APN)及高分子脂聯素(HAP)在膿毒癥中的變化規律、與感染的關繫以及對疾病預後的提示意義.方法 採用前瞻性研究方法,選擇2011年6月至11月本院重癥鑑護病房(ICU)膿毒癥患者80例,採用酶聯免疫吸附試驗(ELISA)檢測入ICU 2 h、2d、6d血漿APN水平(總APN及HAP),併測定降鈣素原(PCT)、內毒素水平,進行急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)、序貫器官衰竭評分(SOFA)、簡化急性生理學評分Ⅱ(SAPSⅡ)評分,計算胰島素牴抗指數;併以20例健康誌願者及21例全身炎癥反應綜閤徵(SIRS)患者作為對照.結果 膿毒癥患者入ICU 2 h血漿總APN(mg/L)及HAP(mg/L)水平較健康對照組和SIRS組顯著下降[總APN:2.87 (2.28,3.89)比6.48±1.53、3.72 (2.67,4.59),HAP:2.64( 2.07,3.75)比5.12±1.98、3.33(2.23,4.24),P＜0.05或P＜0.01],且與PCT水平呈顯著負相關(r1=-0.559,r2=-0.530,均P＜0.01),與內毒素水平均無相關性;通過偏相關分析校正危重患者胰島素牴抗對APN水平造成的影響後髮現,APN與PCT及內毒素的相關性與未校正前基本相同.一般膿毒癥、嚴重感染、感染性休剋組間APN差異存在統計學意義,且與APACHEⅡ、SOFA、SAPSⅡ評分呈顯著負相關(總APN r值分彆為-0.868、-0.766、-0.725,HAP r值分彆為-0.859、-0.715、-0.692,均P＜0.01);膿毒癥存活患者(41例)血漿總APN和HAP水平隨疾病治愈逐漸升高(x21=34.520,x22=27.802,均P＜0.01),死亡患者(7例)總APN、HAP水平則呈下降趨勢(x21=3.938,x22=3.938,均P＞0.05);入ICU 2 h總APN、HAP與ICU住院時間(r1=-0.275,P1=0.014;r2=-0.299,P2=0.007)、機械通氣時間(r1=-0.393,r2=-0.519,均P＜0.01)呈顯著負相關.結論 血漿總APN及HAP在膿毒癥患者中明顯下降,與PCT水平呈負相關,對感染有診斷意義,且與膿毒癥嚴重程度有關,可提示預後.
목적 탐토혈장총지련소(APN)급고분자지련소(HAP)재농독증중적변화규률、여감염적관계이급대질병예후적제시의의.방법 채용전첨성연구방법,선택2011년6월지11월본원중증감호병방(ICU)농독증환자80례,채용매련면역흡부시험(ELISA)검측입ICU 2 h、2d、6d혈장APN수평(총APN급HAP),병측정강개소원(PCT)、내독소수평,진행급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)、서관기관쇠갈평분(SOFA)、간화급성생이학평분Ⅱ(SAPSⅡ)평분,계산이도소저항지수;병이20례건강지원자급21례전신염증반응종합정(SIRS)환자작위대조.결과 농독증환자입ICU 2 h혈장총APN(mg/L)급HAP(mg/L)수평교건강대조조화SIRS조현저하강[총APN:2.87 (2.28,3.89)비6.48±1.53、3.72 (2.67,4.59),HAP:2.64( 2.07,3.75)비5.12±1.98、3.33(2.23,4.24),P＜0.05혹P＜0.01],차여PCT수평정현저부상관(r1=-0.559,r2=-0.530,균P＜0.01),여내독소수평균무상관성;통과편상관분석교정위중환자이도소저항대APN수평조성적영향후발현,APN여PCT급내독소적상관성여미교정전기본상동.일반농독증、엄중감염、감염성휴극조간APN차이존재통계학의의,차여APACHEⅡ、SOFA、SAPSⅡ평분정현저부상관(총APN r치분별위-0.868、-0.766、-0.725,HAP r치분별위-0.859、-0.715、-0.692,균P＜0.01);농독증존활환자(41례)혈장총APN화HAP수평수질병치유축점승고(x21=34.520,x22=27.802,균P＜0.01),사망환자(7례)총APN、HAP수평칙정하강추세(x21=3.938,x22=3.938,균P＞0.05);입ICU 2 h총APN、HAP여ICU주원시간(r1=-0.275,P1=0.014;r2=-0.299,P2=0.007)、궤계통기시간(r1=-0.393,r2=-0.519,균P＜0.01)정현저부상관.결론 혈장총APN급HAP재농독증환자중명현하강,여PCT수평정부상관,대감염유진단의의,차여농독증엄중정도유관,가제시예후.
Objective To explore the regularity of changes in total adiponectin (APN) and high molecular bodyweight adiponectin (HAP) in sepsis,and its correlation with infection and its role on predicting prognosis.Methods A prospective study was conducted.Eighty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medicine University from June to November in 2011 were enrolled in this study.The plasma APN (both total APN and HAP),procalcitonin (PCT),and endotoxin were determined with enzyme linked immunosorbent assay (ELISA) at 2 hours,2 days,and 6 days after ICU admission.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ),sequential organ failure assessment (SOFA),and simplified acute physiology score Ⅱ (SAPS Ⅱ )scores were recorded,and insulin resistance index was calculated.Twenty healthy volunteers and 21 patients with systemic inflammation response syndrome ( SIRS ) were enrolled as controls and SIRS group.Results Plasma totaI APN (mg/L) and HAP (mg/L) in sepsis patients at 2 hours after ICU admission were significantly decreased compared with control group and SIRS group [total APN:2.87 (2.28,3.89) vs.6.48 ± 1.53,3.72 (2.67,4.59); HAP:2.64 (2.07,3.75 ) vs.5.12 ± 1.98,3.33 (2.23,4.24),P＜0.05 or P＜0.01].A negative correlation was found between total APN and HAP in plasma and PCT (r1 =-0.559,r2=-0.530,both P＜0.01 ),but no correlation with endotoxin.Those correlations remained significantly in partial correlation analysis controlled by insulin resistance status.There were significances in APN among sepsis,severe sepsis and septic shock groups,and negative correlations were found between APN and APACHE Ⅱ,SOFA,and SAPS Ⅱ scores (total APN rvalue,-0.868,-0.766,-0.725; HAP r value,-0.859,-0.715,-0.692,all P＜0.01 ).Total APN and HAP in plasma of survivors with sepsis (n=41) was gradually increased following the recovery of the disease (x21=34.520,x22=27.802,both P＜0.01 ) and the level in non-survivors ( n =7 ) was decreased ( x21 =3.938,x22 =3.938,both P＞ 0.05 ).The significantly negative correlations were found between total APN and HAP at 2 hours after ICU admission and ICU duration (r1 =-0.275,P1 =0.014; r2=-0.299,P2=0.007) and ventilation time (r1=-0.393,r2=-0.519,both P＜0.01 ).Conclusions Plasma total APN and HAP was decreased in septic patients,and negatively correlated with PCT.Plasma total APN and HAP played a role in diagnosis of infection and predicting the outcomes,and correlated with severity of sepsis.
