CAJ | 학술논문

目的：观察脓毒症患者血管内皮细胞（VEC）分泌血管性假血友病因子（vWF）、血栓调节蛋白（TM）的变化及乌司他丁的干预作用。方法选择脓毒症患者56例，分为治疗组（n ＝27）及乌司他丁组（n ＝29），两组均给予常规治疗，乌司他丁组加用乌司他丁静脉注射每12小时1次，连续10天；选取健康体检者作为对照组（n ＝20）。检测研究对象治疗前后外周血血清 vWF、TM 的水平；利用脓毒症患者血清作用于体外培养的 VEC 株（CRL-1730），检测培养上清液中可溶性 vWF、TM 的水平，并观察乌司他丁对培养上清液中 vWF、TM 水平的影响。结果治疗前，治疗组 vWF、TM 水平分别为（126．6±19．3）％，（29．8±5．6）μg/L；乌司他丁组 vWF、TM 水平分别为（128．3±6．3）％，（31．7±2．1）μg/L，两组患者 vWF、TM 水平与对照组比较均升高（均 P ＜0．05）；治疗后，两组患者 vWF、TM水平均下降，治疗组 vWF、TM 水平分别为（102．6±31．3）％，（18．9±3．6）μg/L；乌司他丁组 vWF、TM 水平分别为（80．6±26．3）％，（15．1±4．3）μg/L，治疗后乌司他丁组与治疗组比较差异有统计学意义（均 P ＜0．05）；体外实验中，经乌司他丁干预后，细胞培养上清液中 vWF、TM 水平明显下降，分别为（67．1±21．6）％，（13．3±2．5）μg/L，与治疗组比较差异有统计学意义（均 P ＜0．01）。结论脓毒症患者存在 VEC 的损伤，乌司他丁对脓毒症患者的 VEC 损伤有保护作用。
목적：관찰농독증환자혈관내피세포（VEC）분비혈관성가혈우병인자（vWF）、혈전조절단백（TM）적변화급오사타정적간예작용。방법선택농독증환자56례，분위치료조（n ＝27）급오사타정조（n ＝29），량조균급여상규치료，오사타정조가용오사타정정맥주사매12소시1차，련속10천；선취건강체검자작위대조조（n ＝20）。검측연구대상치료전후외주혈혈청 vWF、TM 적수평；이용농독증환자혈청작용우체외배양적 VEC 주（CRL-1730），검측배양상청액중가용성 vWF、TM 적수평，병관찰오사타정대배양상청액중 vWF、TM 수평적영향。결과치료전，치료조 vWF、TM 수평분별위（126．6±19．3）％，（29．8±5．6）μg/L；오사타정조 vWF、TM 수평분별위（128．3±6．3）％，（31．7±2．1）μg/L，량조환자 vWF、TM 수평여대조조비교균승고（균 P ＜0．05）；치료후，량조환자 vWF、TM수평균하강，치료조 vWF、TM 수평분별위（102．6±31．3）％，（18．9±3．6）μg/L；오사타정조 vWF、TM 수평분별위（80．6±26．3）％，（15．1±4．3）μg/L，치료후오사타정조여치료조비교차이유통계학의의（균 P ＜0．05）；체외실험중，경오사타정간예후，세포배양상청액중 vWF、TM 수평명현하강，분별위（67．1±21．6）％，（13．3±2．5）μg/L，여치료조비교차이유통계학의의（균 P ＜0．01）。결론농독증환자존재 VEC 적손상，오사타정대농독증환자적 VEC 손상유보호작용。
Objective To evaluate the influence of ulinastatin on von Willebrand factor (vWF ) and thrombomodulin(TM)of vascular endothelial cells(VEC)of patients with sepsis.Methods Fify-six sepsis patients were divided into therapy group (n = 27)and ulinastatin group (n = 29).Both groups were treated with routine treatment while the ulinastatin group treated with ulinastatin (injection per 12 hours,10 d continuously)in addition. The levels of serum vWF and TM of the sepsis patients before and after 10 days′ treatment with ulinastatin were detected.The VEC (CRL-1730)strains in vitro were cultivated with the serum of the sepsis patients,and the levels of vWF and TM in the supernatant before and after the intervening of ulinastatin were detected.Results Before treatment,the vWF and TM were higher in the serum of the sepsis patitents than those in the healthy group,the vWF was (126.6±19.3)%,and the TM was (29.8±5.6)μg/L in the therapy group,while the vWF was (128.3±6.3)%, and the TM was (31.7±2.1)μg/L in the ulinastatin group.After the treatment,the vWF and TM of both the therapy group and the ulinastatin group were decreased,the vWF was (102.6±31.3)%,and the TM was (18.9±3.6)μg/L in the therapy group,while the vWF was (80.6±26.3)%,and the TM was (15.1±4.3)μg/L in the ulinastatin group. The ulinastatin group compared with the therapy group showed statistical significance (P <0.05).The vWF and TM in the supernatant were decreased significantly in the ulinastatin group (P < 0.01 ),and the vWF was (67.1 ± 21.6)%,the TM was (13.3±2.5)μg/L after the intervening of ulinastatin.Conclusion Ulinastatin can protect VEC injury in sepsis patients.