摘要
目的探究连续性血液净化(continuous blood purification,CBP)治疗对脓毒血症患者血清降钙素原(procalcitonin,PCT)、细胞黏附分子-1(intercellular cell adhesion molecule-1,ICAM-1)、胆碱酯酶(cholinesterase,CHE)和凝血功能的影响。方法将2019年1月至2020年12月期间于我院就诊的146例脓毒血症患者随机分为观察组和对照组各73例,对照组实施常规治疗方案,观察组在对照组基础上予以CBP治疗,比较治疗前及治疗7 d后两组炎性介质[PCT、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、C-反应蛋白(C-reactive protein,CRP)]、血清学指标(ICAM-1、CHE)、凝血功能[凝血酶原时间(prothrombin time,PT)、激活部分凝血酶原时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,Fbg)、血小板计数(platelet count,PLT)]、血流动力学[平均动脉压(mean arterial pressure,MAP)、外周血管阻力指数(system vascular resistance index,SVRI)、中心静脉血氧饱和度(saturation of central venous oxygen,ScvO_(2))]。结果两组治疗前血清PCT(观察组8.63±1.74 ng/mL、对照组8.44±1.79ng/mL)、TNF-α(观察组2.83±0.31g/L、对照组2.80±0.33g/L)、CRP(观察组83.26±10.36mg/L、对照组82.47±10.87mg/L)、ICAM-1(观察组926.86±110.36ng/L、对照组933.17±105.79ng/L)、CHE(观察组4125.39±851.36U/L、对照组4172.85±809.29U/L)、PT(观察组18.42±1.72s、对照组18.36±1.65s)、APTT(观察组41.23±4.39s、对照组41.82±4.05s)、Fbg(观察组1.46±0.43 g/L、对照组1.45±0.40g/L)、PLT[观察组(87.63±13.85)×10^(9)/L、对照组(89.52±12.79)×10^(9)/L]、MAP(观察组10.23±0.79 kPa、对照组10.20±0.83kPa)、SVRI[观察组(58.36±6.53)%、对照组(58.75±6.09)%]、ScvO_(2)(观察组2303.36±156.86 dyn·s/cm^(5)·m^(2)、对照组2287.57±160.28 dyn·s/cm^(5)·m^(2))比较,差异无统计学意义(P均>0.05);治疗7 d后,两组PCT(观察组1.81±0.42ng/mL、对照组3.36±0.86ng/mL)、TNF-α(观察组1.46±0.16g/L、对照组2.17±0.19g/L)、CRP(观察组32.06±5.19mg/L、对照组45.85±6.21mg/L)、ICAM-1(观察组235.18±62.36 ng/L、对照组453.67±89.31g/L)、PT(观察组11.05±1.03s、对照组13.56±1.21s)、APTT(观察组22.46±3.25s、对照组31.29±3.01 s)、ScvO_(2)(观察组1676.86±132.15dyn·s/cm^(5)·m^(2)、对照组1875.74±129.39dyn·s/cm^(5)·m^(2))均较治疗前显著降低,且观察组明显低于同一时间对照组(P<0.05);两组CHE(观察组7215.46±987.21U/L、对照组6102.17±956.19U/L)、Fbg(观察组2.92±0.81g/L、对照组2.43±0.70g/L)、PLT[观察组(145.09±14.29)×10^(9)/L、对照组(122.58±13.29)×10^(9)/L]、MAP(观察组11.46±0.92kPa、对照组10.98±0.87kPa)、SVRI[观察组(75.39±7.85)%、对照组(64.86±5.10)%]水平均较治疗前显著升高(P<0.05),且观察组显著高于对照组(P<0.05)。结论CBP治疗脓毒血症可有效抑制患者炎症状态,下调血清PCT、ICAM-1表达水平,上调CHE表达水平,有助于改善机体凝血功能及血流动力学,具有较高临床应用价值。
Objective To explore the effect of continuous blood purification(CBP)therapy on serum procalcitonin(PCT),intercellular cell adhesion molecule-1(ICAM-1),cholinesterase(CHE)and coagulation function in patients with sepsis.Methods 146 patients with sepsis who were treated in the hospital between January,2019 and December,2020 were randomly divided into the observation group and control group,with 73 cases in each group.The control group received conventional treatment regimen,while the observation group was treated with CBP on the basis of the control group.The inflammatory mediators[PCT,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)],serological indicators(ICAM-1,CHE),coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fbg),platelet count(PLT)]and hemodynamics[mean arterial pressure(MAP),system vascular resistance index(SVRI),saturation of central venous oxygen(ScvO_(2))]were compared between the two groups before treatment and after 7d of treatment.Results Before treatment,there were no statistically significant differences between the observation group and control group in terms of serum PCT(8.63±1.74 ng/mL vs 8.44±1.79ng/mL),TNF-α(2.83±0.31g/L vs 2.80±0.33g/L),CRP(83.26±10.36mg/L vs 82.47±10.87mg/L),ICAM-1(926.86±110.36 ng/L vs 933.17±105.79 ng/L),CHE(4125.39±851.36U/L vs 4172.85±809.29U/L),PT(18.42±1.72 s vs 18.36±1.65 s),APTT(41.23±4.39 s vs 41.82±4.05 s),Fbg(1.46±0.43g/L vs 1.45±0.40g/L),PLT[(87.63±13.85)×10^(9)/L vs(89.52±12.79)×10^(9)/L],MAP(10.23±0.79 kPa vs 10.20±0.83kPa),SVRI[(58.36±6.53)%vs(58.75±6.09)%]and ScvO_(2)(2303.36±156.86 dyn·s/cm^(5)·m^(2) vs 2287.57±160.28 dyn·s/cm^(5)·m^(2))(all P>0.05).After 7d of treatment,PCT(1.81±0.42ng/mL,3.36±0.86 ng/mL),TNF-α(1.46±0.16 g/L,2.17±0.19 g/L),CRP(32.06±5.19 mg/L,45.85±6.21 mg/L),ICAM-1(235.18±62.36 ng/L,453.67±89.31 ng/L),PT(11.05±1.03 s,13.56±1.21 s),APTT(22.46±3.25s,31.29±3.01 s)and ScvO_(2)(1676.86±132.15 dyn·s/cm^(5)·m^(2),1875.74±129.39 dyn·s/cm^(5)·m^(2))in the observation group and the control group were both significantly decreased compared with those before treatment,and the above indicators of the observation group were significantly lower than those of the control group at the same time point(P<0.05).Levels of CHE(7215.46±987.21 U/L,6102.17±956.19 U/L),Fbg(2.92±0.81 g/L,2.43±0.70 g/L),PLT[(145.09±14.29)×10^(9)/L,(122.58±13.29)×10^(9)/L),MAP(11.46±0.92 kPa,10.98±0.87 kPa)and SVRI[(75.39±7.85)%,(64.86±5.10)%)in the observation group and control group were significantly increased compared to before treatment(P<0.05),and levels of the observation group were significantly higher than those of the control group(P<0.05).Conclusion CBP treatment of sepsis can effectively inhibit the inflammatory status,down-regulate expression levels of serum PCT and ICAM-1,up-regulate the expression level of CHE,and help to improve coagulation function and hemodynamics,which suggests a high clinical application value.
作者
万微波
卢蓉
周晶晶
汪超阳
范学朋
胡述立
WAN Weibo;LU Rong;ZHOU Jingjing;WANG Chaoyang;FAN Xuepeng;HU Shuli(Department of Critical Care Medicine, Wuhan First Hospital, Wuhan 430000, China)
出处
《标记免疫分析与临床》
CAS
2021年第12期2055-2059,共5页
Labeled Immunoassays and Clinical Medicine
基金
武汉市医学科研项目(编号:WX21B33)。
关键词
连续性血液净化
脓毒血症
降钙素原
胆碱酯酶
凝血功能
Continuous blood purification
Sepsis
Procalcitonin
Cholinesterase
Coagulation function
