【摘要】 目的观察重症脓毒症患者血清LBP及sCD14的变化规律,探讨尿胰蛋白酶抑制剂的作用及可能的作用机制。方法用酶联免疫吸附(ELISA)法测定40例重症脓毒症患者各时点的血清LBP和sCD14浓度。将其随机分为乌司他丁组(U组)与对照组(C组),在相同的常规治疗基础上,U组给予乌司他丁针剂20万U静脉注射,2次/d,持续5 d。C组则给予同等量的生理盐水作为安慰剂对照。在治疗前、治疗后第2,3,6天抽取右侧桡动脉血测定血清LBP及sCD14的浓度,观察其动态变化的规律,并统计两组患者28 d的病死率。结果重症脓毒症患者在诊断成立的第2天血清LBP及sCD14水平达高峰并随后回落,第6天LBP水平仍高于正常而sCD14水平则降至正常范围。死亡组血清sCD14水平较存活组有升高,在第6天差异才具有统计学意义。治疗前两组患者APACHEⅡ评分值相似(P>0.05),U组患者28 d的病死率为18.2%(4/22),C组为50.0% (9/18),差异具有统计学意义(P<0.05)。治疗5 d后,血清sCD14水平在U组有下降(P<0.05)。结论血清sCD14水平可以作为判断重症脓毒症患者预后的指标之一;尿胰蛋白酶抑制剂能够改善脓毒症患者的预后,降低病死率,可能与其改变脓毒症患者血清中sCD14的水平有关。更多还原

【Abstract】 Objective To investigate the changes of serum lipopolysaccharide-binding protein (LBP) and soluble CD14 (sCD14) levels in severe sepsis patients, and to evaluate the efficacy and the possible mechanism of ulinastatin in those patients. Method Blood samples were obtained within 24 hours after onset of severe sepsis (day 0) and at 2 days, 3 days and 6 days. Serum concentration of LBP and sCDI4 were measured by enzyme linked immunosorbent assay (ELISA). Forty patients were randomly divided into ulinastatin treatment group (group U) and control group (group C). Patients in group U received ulinastatin 200 000 units intravenously twice a day for 5 days, while those in group C received equal quantity of normal saline as placebo. Before treatment, APACHEⅡscores were recorded. The dynamic changes of serum LBP and sCD14 were observed in those patients. Mortality rate was compared at 28 days after treatment between the two groups. Results Significantly higher serum concentration of LBP and sCD14 were found in severe sepsis patients (P<0.01). The concentration of LBP and sCD14 elevated to the maximum at 2 days and then tended downwards. At 6 days, the concentration of LBP in severe sepsis patients was stilt higher than that in the healthy subjects, while the concentration of sCD14 was no difference between the severe sepsis patients and the healthy indiridual. There was no significant difference in LBP serum levels between non-survivors and survivors. But sCD14 serum levels were higher in non-survivors at 6 days. Before treatment, the APACHE score of group U was similar to that of and group C (P>0.05). Mortality rate at 28 days was 18.2% (4/22) in group U and lower than that in group C, 50.0% (9/18)(P<0.05). Conclusions Significantly higher serum concentration of LBP and sCDi4 was found in severe sepsis patients. Serum sCD14 level can be regarded as a prognostic marker in patients with severe sepsis. Ulinastatin improved the out come of patients with severe sepsis, reduced 28-day mortality of those patients. The potential mechanism was likely associated with the change of serum sCD14 level after using Ulinastatin.更多还原