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目的探讨小剂量肝素治疗脓毒症中患者血栓烷B2(TXB2)、6-酮-前列腺素F1α(6-keto-PGF1α)表达的动态变化及其临床意义。方法 21例健康体检者为正常对照组。将40例脓毒症患者随机分为对照组(19例)和抗凝组(21例),分别在第1、4、7、10天采集静脉血,用ELISA方法检测3组的TXB2及6-keto-PGF1α的水平,并计算TXB2/6-keto-PGF1α的比值。用生化仪测定血小板(PLT)计数、血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)的变化,同时观察急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分,并计算28 d病死率。结果对照组与正常对照组比较,TXB2、6-keto-PGF1α表达明显增加,差异有统计学意义(P<0.05)。抗凝组随着时间的延长TXB2表达、TXB2/6-keto-PGF1α的比值和APACHEⅡ评分均下降,第7、10天与第1、4天比较差异有统计学意义(P<0.05);6-keto-PGF1α轻度上升,差异无统计学意义(P>0.05)。APACHEⅡ评分第10天与第1天比较差异有统计学意义(P<0.05)。而对照组3指标略有上升,但差异无统计学意义(P>0.05)。抗凝组与对照组比较,TXB2和TXB2/6-keto-PGF1α比值在第7、10天差异有统计学意义(P<0.05)。28 d病死率23.8%(5/21)也较对照组26.3%(5/19)降低,但差异无统计学意义(P>0.05)。两组治疗前后PT、APTT、FIB、PLT和D-D值差异无统计学意义(P>0.05)。相关性分析显示,入院时TXB2、TXB2/6-keto-PGF1α比值及APACHEⅡ评分呈正相关(r分别为0.827和0.785,P<0.05)。结论应用小剂量肝素持续泵入治疗脓毒症可显著抑制TXB2,并可降低代表抗凝/促凝的指标TXB2/6-keto-PGF1α比值,有利于机体抗凝/促凝达到平衡,并有可能改善预后,且临床应用安全。TXB2和TXB2/6-keto-PGF1α比值有可能是预测脓毒症病情严重程度的一个新指标。
Objective To investigate the dynamic changes of thromboxane B2 (TXB2) and 6-keto-PGF1α in sepsis patients treated with low-dose heparin and its clinical significance. Methods 21 healthy subjects were normal control group. Forty patients with sepsis were randomly divided into control group (n = 19) and anticoagulation group (n = 21). Venous blood was collected on days 1, 4, 7 and 10, and TXB2 and 6 -keto-PGF1α, and calculate the ratio of TXB2 / 6-keto-PGF1α. The platelet count, plasma prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) were measured with a biochemical analyzer. The acute physiology and chronic health status Ⅱ (APACHE Ⅱ ) Score, and calculate the 28 d mortality. Results Compared with the normal control group, the expression of TXB2, 6-keto-PGF1α increased significantly (P <0.05). TXB2 expression, TXB2 / 6-keto-PGF1α ratio and APACHEⅡscore decreased in the anticoagulation group over time, and there was significant difference between the 7th and 10th days and the first and the fourth days (P <0.05); 6 -keto-PGF1α slightly increased, the difference was not statistically significant (P> 0.05). APACHE Ⅱ score on the 10th day and the first day difference was statistically significant (P <0.05). The control group 3 index increased slightly, but the difference was not statistically significant (P> 0.05). Compared with the control group, the ratio of TXB2 and TXB2 / 6-keto-PGF1α in the anticoagulation group was statistically significant at the 7th and 10th days (P <0.05). The 28-day mortality was 23.8% (5/21) compared with 26.3% (5/19) in the control group, but the difference was not statistically significant (P> 0.05). There was no significant difference in PT, APTT, FIB, PLT and D-D between the two groups before and after treatment (P> 0.05). Correlation analysis showed that TXB2, TXB2 / 6-keto-PGF1α ratio and APACHE Ⅱ score were positively correlated (r = 0.827 and 0.785, P <0.05). CONCLUSIONS: Continuous low-dose heparin pump treatment of sepsis can significantly inhibit TXB2 and decrease the ratio of TXB2 / 6-keto-PGF1α, which represents the anticoagulant / procoagulant index, which is in favor of the balance of anticoagulant / procoagulant in the body and May improve the prognosis, and clinical application of safety. The ratio of TXB2 to TXB2 / 6-keto-PGF1α may be a new predictor of the severity of sepsis.