【摘要】 目的探讨严重烧伤患者内毒素增敏系统——脂多糖结合蛋白/脂多糖受体CD14(LBP/CD14)的变化与严重脓毒症的关系及其临床意义。方法选择35例烧伤体表总面积大于30%患者,根据烧伤脓毒症的定义和诊断标准分为脓毒症组(19例)和非脓毒症组(16例),应用酶联免疫吸附试验检测患者烧伤后1、3、5、7、14、21、28d血浆LBP、可溶性CD14(sCD14)及白细胞介素6(IL-6)的水平。另选择11例健康献血员作为正常对照组。结果与正常对照组比较,严重烧伤患者伤后血浆LBP、sCD14及IL-6水平均有显著升高(P<0.01),并发脓毒症的患者血浆LBP水平在伤后3、14、21、28d较未发生脓毒症患者明显升高,血浆sCD14及IL-6水平在烧伤后特别是14～28d显著高于非脓毒症患者(P<0.05或P<0.01),且与LBP水平呈明显正相关(P<0.05或P<0.01)。结论严重烧伤后内毒素增敏系统参与了脓毒症的病理生理反应。动态监测循环LBP/CD14的变化有助于了解脓毒症的发生与发展过程。更多还原

【Abstract】 Objective To explore the relationship between the changes of lipopolysaccharide-binding protein(LBP) and CD14 as a sensitization system of endotoxin and severe burn sepsis,and investigate the clinical significance of the relationship.Methods Thirty-five severe burn patients(>30% TBSA) were involved in present study and divided into sepsis group(n=19) and non-sepsis group(n=16) based on the definition and diagnosis standard of sepsis.The blood samples were collected on day 1,3,5,7,14,21 and 28 after burn and the plasma levels of LBP,soluble CD14(sCD14) and interleukin-6(IL)-6 were measured by enzyme-linked immunosorbent assay(ELISA).Eleven healthy blood donors were chosen as controls.Results Plasma levels of LBP,sCD14 and IL-6 were markedly elevated in severe burn patients compared with those in controls(P<0.01).LBP levels were significantly higher in sepsis group than in non-sepsis group on day 3,14,21 and 28 after burn(P<0.05 or 0.01).Plasma levels of sCD14 and IL-6 elevated significantly in sepsis group than in non-sepsis group during later stage,especially on day 14 to 28 after burn(P<0.05 or 0.01).In addition,there existed a significant positive correlation between sCD14/IL-6 and LBP levels(P<0.05 or 0.01).Conclusions Endotoxin sensitization system participates in the postburn pathophysiological processes.Dynamically monitoring the levels of LBP and sCD14 may be helpful to understand the development of postburn sepsis.更多还原