摘要
目的检测脓毒症及合并弥漫性血管内凝血（DIC）患者血清金属蛋白酶组织抑制剂（tissue inhibitor of metalloproteinase, TIMP）水平，并判断其对脓毒症患者发展成为DIC的预测诊断价值。方法取60名患者，其中严重脓毒症患者28例（SS组），脓毒症合并DIC患者12例（SSD组），同期门诊体检者20例为对照组，收集临床及实验室参数，计算APACHEⅡ评分和DIC评分，采用酶联免疫吸附（ELISA）方法检测血清TIMP-1和TIMP-2的水平。结果SS组患者血清TIMP-1水平（723．74±96．27）较对照组（574．24±79．99）明显升高（P〈0．05），TIMP-2水平（68．08±14．87）较对照组（89．99±18．45）明显降低（P〈0．05）。SSD组患者血清TIMP-1水平（907．56±200．20）则较SS组升高明显（P〈0．05），而TIMP-2水平（44．84±22．13）也较ss组降低更明显（P〈0．05）。相关分析显示TIMP-1主要与纤维蛋白原（FIB）呈负相关，差异具有统计学意义（P〈0．05），而与D-二聚体呈正相关，差异具有统计学意义（P〈0．05）；血清TIMP-2则与血小板计数（PⅡ）、降钙素原（PCT）、DIC评分呈负相关，差异具有统计学意义（P〈0．05）。ROC曲线图显示TIMP-1／TIMP-2的AUC=0．896，95％CI：0．843-0．950（P〈0．05），较TIMP-1或TIMP-2的AUC更高。结论脓毒症合并DIC患者的血清TIMP-1水平明显升高，主要影响纤溶系统；TIMP-2水平明显下降，主要影响血小板功能；TIMP-1／TIMP-2对脓毒症合并DIC的发生具有诊断价值。
Objective To examine the levels of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intra-vascular coagulation （DIC） and evaluate its diagnostic value in severe sepsis with DIC. Methods Sixty patients were divided into 3 groups, namely severe sepsis group （SS group, n = 28）, severe sepsis with DIC group （ SSD group, n = 12） and normal group （ n = 20）. Clinical data ineluding APACHE Ⅱ score and DIC score of these patients were collected. Serum levels of TIMP-1 and TIMP-2 of these patients were measured by using ELISA. Results The patients of SS group had higher levels of TIMP-1 （723.74 ± 96. 27 ） and lower levels of TIMP-2 （68.08 ± 14. 87 ） than healthy control subjects （TIMP-1 ： 574. 24± 79.99, TIMP-2 ： 89.99 ± 18.45） （P 〈 0. 05）. The patients of SSD group had higher levels of TIMP-1 （907. 56 ± 200. 20） and lower levels of TIMP-2 （44. 84 ± 22. 13 ） than patients of SS group （P 〈 0. 05 ）. An association was found between TIMP-1 and fibrinogen （FIB） （r = - 0. 392, P 〈 0.05）, TIMP-1 and D-dimer （ r = 0. 407, P 〈 0. 05 ）, TIMP-2 and PLT （ r = 0. 484, P 〈0. 01 ）, TIMP-2 and PCT （r = - 0. 523, P 〈 0.01 ）, TIMP-2 and DIC score （ r = - 0. 579, P 〈 0. 01 ）. The areas under the curves （AUC） for TIMP-1/TIMP-2 was 0. 896 （95% CI： 0. 843 - 0. 950 （ P 〈 0. 05 ）. Conclusions Serum levels of TIMP-1 in patients with severe sepsis complicated with DIC increased and TIMP-2 decreased, suggesting they were valuable in diagnosis of severe sepsis complicated with DIC.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第11期1242-1246,共5页
Chinese Journal of Emergency Medicine
关键词
脓毒症
弥漫性血管内凝血
金属蛋白酶组织抑制剂
Severe sepsis
Disseminated intravascular coagulation
Tissue inhibitor ofmetalloproteinase
