CAJ | 학술논문

目的探讨脓毒血症患者热休克蛋白(heat shock protein,HSPs)70含量与疾病严重程度相关关系,及其对病情预后的判断价值.方法选择2009年4月至2010年11月上海市浦东新区公利医院院急诊科收治确诊脓毒症患者120例进行前瞻性研究,按照SAPSⅡ评分法分为轻、中、重3组,每组40例.另选40例年龄、性别、体质量构成与上述各组差异无统计学意义的体检健康人群作为健康对照组.又根据患者最后转归分为死亡组和存活组.患者入院后立即外周静脉采血5 mL,用流式细胞术测定实验组患者外周血中性粒细胞胞内HSPs70的水平,以及血清中降钙素原(PCT)、C-反应蛋白(CRP)含量.单因素方差分析比较各组间HSPs70,PCT、CRP的变化差异.结果 ①脓毒症患者中性粒细胞胞内热休克蛋白(HSPs)70的含量随SAPS Ⅱ评分增高而逐渐升高,轻度、中度、重度脓毒症之间差异具有统计学意义(P<0.05);血清降钙素原(PCT)含量也随SAPSⅡ评分增高逐渐升高,轻度与重度脓毒症之间差异具有统计学意义(P<0.05).②在所有脓毒症患者中,死亡患者均出现在重度组内,与其他标志物相比,死亡患者的热休克蛋白HSPs70的含量比存活患者明显升高(P<0.05).③在脓毒症患者的受试工作者曲线分析中,中性粒细胞胞内热休克蛋白(HSPs)70的含量与PCT、CRP相比,曲线下面积明显增多.结论热休克蛋白HSPs70对脓毒症患者病情及预后判断有一定的临床价值.
목적 탐토농독혈증환자열휴극단백(heat shock protein,HSPs)70함량여질병엄중정도상관관계,급기대병정예후적판단개치.방법 선택2009년4월지2010년11월상해시포동신구공리의원원급진과수치학진농독증환자120례진행전첨성연구,안조SAPSⅡ평분법분위경、중、중3조,매조40례.령선40례년령、성별、체질량구성여상술각조차이무통계학의의적체검건강인군작위건강대조조.우근거환자최후전귀분위사망조화존활조.환자입원후립즉외주정맥채혈5 mL,용류식세포술측정실험조환자외주혈중성립세포포내HSPs70적수평,이급혈청중강개소원(PCT)、C-반응단백(CRP)함량.단인소방차분석비교각조간HSPs70,PCT、CRP적변화차이.결과 ①농독증환자중성립세포포내열휴극단백(HSPs)70적함량수SAPS Ⅱ평분증고이축점승고,경도、중도、중도농독증지간차이구유통계학의의(P<0.05);혈청강개소원(PCT)함량야수SAPSⅡ평분증고축점승고,경도여중도농독증지간차이구유통계학의의(P<0.05).②재소유농독증환자중,사망환자균출현재중도조내,여기타표지물상비,사망환자적열휴극단백HSPs70적함량비존활환자명현승고(P<0.05).③재농독증환자적수시공작자곡선분석중,중성립세포포내열휴극단백(HSPs)70적함량여PCT、CRP상비,곡선하면적명현증다.결론 열휴극단백HSPs70대농독증환자병정급예후판단유일정적림상개치.
Objective To investigate the relationships between the level of heat shock protein (HSPs) 70 and severity of sepsis in order to find its effects on the status of sepsis and the prognosis of the patients. Methods In total, 120 patients diagnosed to be suffering from sepsis from the emergency department were selected as studying subjects. According to SAPS Ⅱ score, all of these patients were divided into mild, moderate and severe groups (n =40 in each group) , and at the same time, 40 healthy volunteers were studied as controls. The levels of intracellular HSPs70 in peripheral blood neutrophil cells in the mild, moderate and severe groups were determined by using flow cytometry, while serum levels of procalcitonin (PCT) and C-reactive protein ( CRP) were measured as well. Results ① The levels of heat shock proteins HSPs70 in neutrophil cells and PCT in patients with sepsis escalated gradually with the increase in SAPS Ⅱ score, and there were significant different among the mild, moderate, and severe sepsis groups(P<0.05). ② In all septic patients, the death happened only in the severe group. Compared other markers in the survivals , the level of heat shock protein HSPs70 was significantly higher in fatal patients. ③ In curve plot analysis in the patients with sepsis done by the curve of receiver operating characteristic (ROC) , the area of HSPs70 in neutrophil cells under the curve was significantly larger as compared with that of PCT and CRP. Conclusions Heat shock protein HSPs70 has a certain clinical value in determining the severity of disease and prognosis of patients suffering from sepsis.