目的探讨腹腔感染并腹腔内高压(IAH)患者血浆Apelin水平变化及其与腹腔内压力(IAP)的关系.方法选择2008年7月至2012年5月本院重症医学科收治的成人腹腔感染患者43例,根据IAP分为单纯腹腔感染(OIN)组9例,IAH组18例及腹腔间隔室综合征(ACS)组16例,以同期17例健康志愿者为健康对照组.检测患者入住重症监护病房(ICU)时血浆Apelin、降钙素原(PCT)、C-反应蛋白(CRP)、N末端脑钠肽前体(NF-proBNP)、血小板计数(PLT)、白细胞计数(WBC)、血乳酸(Lac)、血浆白蛋白(Alb)、出凝血指标、肌酐(Cr)和IAP水平;将患者再按是否行腹腔减压术分为非手术组(12例)及手术组(31例).于术前及术后1、3、5 d 经肘静脉取血,采用放射免疫法(RIA)测定血浆Apelin水平,并观察血浆Apelin与IAP水平的相关性.结果①与健康对照组比较,OIN组、IAH组、ACS组性别、年龄比较差异均无统计学意义(均P>0.05);3组CRP(mg/L)、PCT(μg/L)、Lac(mmol/L)、Apelin(ng/L)、NT-proBNP(ng/L)、凝血酶原时间(PT,s)、活化部分凝血活酶时间(APTT,s)、Cr(μmol/L)、IAP(mm Hg,1mm Hg=0.133 kPa)均升高,以ACS组升高更显著(CRP:18.4±2.2比6.4±1.5,PCT:14.2±9.7比0.2±0.1,Lac:2.3±0.8比1.5±0.6,Apelin:148.3±34.9比57.1±28.3,NT-proBNP:934.5±320.3比596.7±240.7,PT:19.7±9.1比13.6±0.5,APTT:58.2±29.7比33.6±8.4,Cr:148.4±39.5比77.9±21.3,IAP:24.8±4.2比3.9±1.6,P<0.05或 P<0.01);OIN组和IAH组WBC均升高,ACS组降低(13.3±0.3、16.7±0.5、1.0±0.8比5.9±0.6,均P<0.01);3组PLT (×109/L)、血浆Alb(g/L)水平均降低,以ACS组降低更显著(PLT:99.7±34.7比196.2±40.1,Alb:24.8±10.3比39.1±11.4,均P<0.05).②术后3 d、5 d,手术组Apelin水平(ng/L)均较非手术组明显降低,以术后3 d下降更快(88.3±27.6比103.8±29.1,P<0.01).③患者血浆Apelin水平与IAP水平呈显著正相关(r=0.585, P<0.05).结论腹腔感染患者血浆Apelin水平升高,以ACS升高明显,腹腔减压后,血浆Apelin浓度下降,其水平与腹腔灌注压呈正相关.提示Apelin参与腹腔感染基础上的IAH及ACS的病理生理过程,有一定的临床意义.
目的探討腹腔感染併腹腔內高壓(IAH)患者血漿Apelin水平變化及其與腹腔內壓力(IAP)的關繫.方法選擇2008年7月至2012年5月本院重癥醫學科收治的成人腹腔感染患者43例,根據IAP分為單純腹腔感染(OIN)組9例,IAH組18例及腹腔間隔室綜閤徵(ACS)組16例,以同期17例健康誌願者為健康對照組.檢測患者入住重癥鑑護病房(ICU)時血漿Apelin、降鈣素原(PCT)、C-反應蛋白(CRP)、N末耑腦鈉肽前體(NF-proBNP)、血小闆計數(PLT)、白細胞計數(WBC)、血乳痠(Lac)、血漿白蛋白(Alb)、齣凝血指標、肌酐(Cr)和IAP水平;將患者再按是否行腹腔減壓術分為非手術組(12例)及手術組(31例).于術前及術後1、3、5 d 經肘靜脈取血,採用放射免疫法(RIA)測定血漿Apelin水平,併觀察血漿Apelin與IAP水平的相關性.結果①與健康對照組比較,OIN組、IAH組、ACS組性彆、年齡比較差異均無統計學意義(均P>0.05);3組CRP(mg/L)、PCT(μg/L)、Lac(mmol/L)、Apelin(ng/L)、NT-proBNP(ng/L)、凝血酶原時間(PT,s)、活化部分凝血活酶時間(APTT,s)、Cr(μmol/L)、IAP(mm Hg,1mm Hg=0.133 kPa)均升高,以ACS組升高更顯著(CRP:18.4±2.2比6.4±1.5,PCT:14.2±9.7比0.2±0.1,Lac:2.3±0.8比1.5±0.6,Apelin:148.3±34.9比57.1±28.3,NT-proBNP:934.5±320.3比596.7±240.7,PT:19.7±9.1比13.6±0.5,APTT:58.2±29.7比33.6±8.4,Cr:148.4±39.5比77.9±21.3,IAP:24.8±4.2比3.9±1.6,P<0.05或 P<0.01);OIN組和IAH組WBC均升高,ACS組降低(13.3±0.3、16.7±0.5、1.0±0.8比5.9±0.6,均P<0.01);3組PLT (×109/L)、血漿Alb(g/L)水平均降低,以ACS組降低更顯著(PLT:99.7±34.7比196.2±40.1,Alb:24.8±10.3比39.1±11.4,均P<0.05).②術後3 d、5 d,手術組Apelin水平(ng/L)均較非手術組明顯降低,以術後3 d下降更快(88.3±27.6比103.8±29.1,P<0.01).③患者血漿Apelin水平與IAP水平呈顯著正相關(r=0.585, P<0.05).結論腹腔感染患者血漿Apelin水平升高,以ACS升高明顯,腹腔減壓後,血漿Apelin濃度下降,其水平與腹腔灌註壓呈正相關.提示Apelin參與腹腔感染基礎上的IAH及ACS的病理生理過程,有一定的臨床意義.
목적탐토복강감염병복강내고압(IAH)환자혈장Apelin수평변화급기여복강내압력(IAP)적관계.방법선택2008년7월지2012년5월본원중증의학과수치적성인복강감염환자43례,근거IAP분위단순복강감염(OIN)조9례,IAH조18례급복강간격실종합정(ACS)조16례,이동기17례건강지원자위건강대조조.검측환자입주중증감호병방(ICU)시혈장Apelin、강개소원(PCT)、C-반응단백(CRP)、N말단뇌납태전체(NF-proBNP)、혈소판계수(PLT)、백세포계수(WBC)、혈유산(Lac)、혈장백단백(Alb)、출응혈지표、기항(Cr)화IAP수평;장환자재안시부행복강감압술분위비수술조(12례)급수술조(31례).우술전급술후1、3、5 d 경주정맥취혈,채용방사면역법(RIA)측정혈장Apelin수평,병관찰혈장Apelin여IAP수평적상관성.결과①여건강대조조비교,OIN조、IAH조、ACS조성별、년령비교차이균무통계학의의(균P>0.05);3조CRP(mg/L)、PCT(μg/L)、Lac(mmol/L)、Apelin(ng/L)、NT-proBNP(ng/L)、응혈매원시간(PT,s)、활화부분응혈활매시간(APTT,s)、Cr(μmol/L)、IAP(mm Hg,1mm Hg=0.133 kPa)균승고,이ACS조승고경현저(CRP:18.4±2.2비6.4±1.5,PCT:14.2±9.7비0.2±0.1,Lac:2.3±0.8비1.5±0.6,Apelin:148.3±34.9비57.1±28.3,NT-proBNP:934.5±320.3비596.7±240.7,PT:19.7±9.1비13.6±0.5,APTT:58.2±29.7비33.6±8.4,Cr:148.4±39.5비77.9±21.3,IAP:24.8±4.2비3.9±1.6,P<0.05혹 P<0.01);OIN조화IAH조WBC균승고,ACS조강저(13.3±0.3、16.7±0.5、1.0±0.8비5.9±0.6,균P<0.01);3조PLT (×109/L)、혈장Alb(g/L)수평균강저,이ACS조강저경현저(PLT:99.7±34.7비196.2±40.1,Alb:24.8±10.3비39.1±11.4,균P<0.05).②술후3 d、5 d,수술조Apelin수평(ng/L)균교비수술조명현강저,이술후3 d하강경쾌(88.3±27.6비103.8±29.1,P<0.01).③환자혈장Apelin수평여IAP수평정현저정상관(r=0.585, P<0.05).결론복강감염환자혈장Apelin수평승고,이ACS승고명현,복강감압후,혈장Apelin농도하강,기수평여복강관주압정정상관.제시Apelin삼여복강감염기출상적IAH급ACS적병리생리과정,유일정적림상의의.
Objective To evaluate the change of plasma Apelin in patients of abdominal infection with intra-abdominal hypertension(IAH)and the relationship between Apelin plasma concentration and intra-abdominal pressure(IAP). Methods According to the level of IAP,43 patients with intra-abdominal infection in department of critical care medicine from July 2008 to May 2012 were divided into only intra-abdominal infection(OIN)group (9 cases),IAH group(18 cases)and abdominal compartment syndrome(ACS)group(16 cases);17 volunteers in the corresponding period were enrolled as the healthy control group in the study. The levels of plasma Apelin,procalcitonin (PCT),C-reactive protein(CRP),N-terminal pro-brain natriuretic peptide(NT-proBNP),platelet count(PLT), white blood cell(WBC)count,blood lactate(Lac),plasma albumin(Alb),coagulation parameters,creatinine(Cr) and IAP were monitored when the patients were admitted into intensive care unit(ICU). According to whether the patient was necessary to perform the abdominal decompression operation,the patients were divided into no operation group(12 cases)and operation group(31 cases). The blood was collected from the ulnar vein before operation and 1,3,5 days after operation. The concentrations of plasma Apelin were measured by radioimmunoassay(RIA). The correlation between the concentration of plasma Apelin and the level of IAP was evaluated. Results ①There were no differences in sex and age in OIN,IAH and ACS group compared with the healthy control group (all P>0.05);the CRP(mg/L),PCT(μg/L),Lac(mmol/L),Apelin(ng/L),NT-proBNP(ng/L),prothrombin time (PT,s),activated partial thromboplastin time(APTT,s),Cr(μmol/L),IAP(mm Hg,1 mm Hg=0.133 kPa)in OIN, IAH and ACS groups were significantly increased,especially in ACS group(CRP:18.4±2.2 vs. 6.4±1.5,PCT:14.2±9.7 vs. 0.2±0.1,Lac:2.3±0.8 vs.1.5±0.6,Apelin:148.3±34.9 vs. 57.1±28.3,NT-proBNP:934.5±320.3 vs. 596.7±240.7,PT:19.7±9.1 vs. 13.6±0.5,APTT:58.2±29.7 vs. 33.6±8.4,Cr:148.4±39.5 vs. 77.9±21.3, IAP:24.8±4.2 vs. 3.9±1.6,P<0.05 or P<0.01);the levels of WBC were increased in OIN and IAH groups,but the level was reduced in ACS group compared with that in the healthy control group(13.3±0.3,16.7±0.5,1.0±0.8 vs. 5.9±0.6,all P<0.01);the PLT(×109/L)and plasma Alb(g/L)were reduced in OIN,IAH and ACS groups compared with those in healthy control group,especially in ACS group(PLT:99.7±34.7 vs. 196.2±40.1,Alb:24.8±10.3 vs. 39.1±11.4,both P<0.05).② Three days and 5 days after abdominal decompression operation,the level of plasma Apelin(ng/L)in operation group was significantly reduced compared with that of no operation group,and the reduction was more prominent on the 3rd day after the operation(88.3±27.6 vs. 103.8±29.1, P<0.01).③The plasma Apelin concentration in patients of abdominal infection was significantly positively correlated with the level of IAP(r=0.585,P<0.05). Conclusions The level of plasma Apelin is elevated in patients with intra-abdominal infection,especially prominent in patients with ACS,and after abdominal decompression operation,its plasma level is lowered and positively correlated with the height of IAH,suggesting that Apelin might be involved in the patho-physiological process in IAH and ACS on the basis of abdominal infection and have certain clinical significance.
