CAJ | 학술논문

目的：初步分析细菌感染致脓毒症患者血小板（PLT）减少原因，并研究区分革兰阳性（G＋）细菌与革兰阴性（G －）细菌生化特征，为临床早期预防多器官衰竭，降低死亡率提供依据。方法检测155例脓毒症患者组、56例非脓毒血症患者（感染组）和43例非感染对照组的血小板计数、降钙素原（PCT）、C-反应蛋白（CRP）、白细胞（WBC）、中性粒细胞（NE）百分比及 Bcl-xL 蛋白水平，对上述3组患者的6项指标进行统计学分析。同时进行血细菌培养，将75例血培养阳性的脓毒症患者分为 G ＋组和 G －组，检测分析2组间 PLT、PCT 结果、Bcl-xL 蛋白水平及在不同 PCT 截值的百分比。结果脓毒症患者组生化指标与对照组相比差异均有统计学意义（P ＜0．01）；与感染组比较，PLT、PCT、CRP 和 Bcl-xL 水平差异均有统计学意义（P ＜0．01），WBC 和中性粒细胞百分比差异均无统计学意义（P ＞0．05）；感染组患者 PCT、CRP、WBC、中性粒细胞百分比与对照组相比，差异均有统计学意义（P ＜0．01），但 PLT 和 Bcl-xL 差异均无统计学意义（P ＞0．05）。同时发现，G ＋细菌与 G －细菌脓毒症患者在 PCT ＜2．0 ng／mL 时，百分率差异无统计学意义（P ＞0．05）；2．0 ng／mL≤PCT≤10．0 ng／mL 时，G ＋组患者的百分率明显高于 G －组（P ＜0．01）；而在 PCT≥10．0 ng／mL 时，G －组患者百分率明显高于 G ＋组（P ＜0．01）。G －细菌性脓毒症组 PLT、PCT 水平均低于 G ＋细菌性脓毒症组（P ＜0．01）。结论脓毒症患者出现 PLT 减少、PCT升高与细菌作用于 Bcl-xL 启动 PLT 凋亡程序有关；G －细菌致脓毒症较 G ＋细菌更易启动 PLT 凋亡，具有更高危险性。
목적：초보분석세균감염치농독증환자혈소판（PLT）감소원인，병연구구분혁란양성（G＋）세균여혁란음성（G －）세균생화특정，위림상조기예방다기관쇠갈，강저사망솔제공의거。방법검측155례농독증환자조、56례비농독혈증환자（감염조）화43례비감염대조조적혈소판계수、강개소원（PCT）、C-반응단백（CRP）、백세포（WBC）、중성립세포（NE）백분비급 Bcl-xL 단백수평，대상술3조환자적6항지표진행통계학분석。동시진행혈세균배양，장75례혈배양양성적농독증환자분위 G ＋조화 G －조，검측분석2조간 PLT、PCT 결과、Bcl-xL 단백수평급재불동 PCT 절치적백분비。결과농독증환자조생화지표여대조조상비차이균유통계학의의（P ＜0．01）；여감염조비교，PLT、PCT、CRP 화 Bcl-xL 수평차이균유통계학의의（P ＜0．01），WBC 화중성립세포백분비차이균무통계학의의（P ＞0．05）；감염조환자 PCT、CRP、WBC、중성립세포백분비여대조조상비，차이균유통계학의의（P ＜0．01），단 PLT 화 Bcl-xL 차이균무통계학의의（P ＞0．05）。동시발현，G ＋세균여 G －세균농독증환자재 PCT ＜2．0 ng／mL 시，백분솔차이무통계학의의（P ＞0．05）；2．0 ng／mL≤PCT≤10．0 ng／mL 시，G ＋조환자적백분솔명현고우 G －조（P ＜0．01）；이재 PCT≥10．0 ng／mL 시，G －조환자백분솔명현고우 G ＋조（P ＜0．01）。G －세균성농독증조 PLT、PCT 수평균저우 G ＋세균성농독증조（P ＜0．01）。결론농독증환자출현 PLT 감소、PCT승고여세균작용우 Bcl-xL 계동 PLT 조망정서유관；G －세균치농독증교 G ＋세균경역계동 PLT 조망，구유경고위험성。
Objective To analyze primarily the difference causes of thrombocytopenia by different bacterial infections in patients with sepsis,to distinguish the biochemical characteristics of Gram-positive bacteria (G +)and Gram-negative bacteria (G -),and to provide the reference for the clinical early prevention of multiple organ failure and reduce the mortality rate.Methods A total of 1 55 sepsis patients,56 patients with non-sepsis (infection group)and 43 non-infected controls were enrolled,and their platelet (PLT),procalcitonin (PCT),C reactive protein (CRP), white blood cell (WBC),the percentage of neutrophils (NE)and Bcl-xL protein levels were determined.The results were analyzed statistically.Blood culture was performed simultaneously,75 cases of blood culture-positive sepsis patients were classified into G + and G - groups.Their PLT,PCT,Bcl-xL protein and different PCT cross-section percentages were analyzed.Results Biochemical parameters of sepsis group had obvious difference with those of control group (P <0.01 ).Compared with infection group,serum PLT,PCT,CRP and Bcl-xL protein levels were significantly different (P <0.01 ),and WBC and the percentage of NE had no statistical significance (P >0.05).In infection group,PCT,CRP,WBC,NE percentage had statistical significance compared with those in control group (P <0.01 ), but the differences of PLT and Bcl-xL protein were not significant (P > 0.05 ).For G + and G - groups in sepsis patients,when PCT <2.0 ng/mL,there was no statistical significance (P >0.05 ).When 2.0 ng/mL ≤ PCT≤1 0.0 ng/mL,the percentage in G + group was significantly higher than that in G - group (P <0.01 ).When PCT ≥1 0.0 ng/mL,the percentage in G-group was significantly higher than that in G + group (P <0.01 ).PLT and PCT levels in G - group were lower than those in G + group (P <0.01 ).Conclusions The reduction of PLT and the increase of PCT are related to the apoptosis of PLT caused by Bcl-xL protein.G - sepsis is easier to start PLT apoptosis than G + sepsis with higher risk.