急性脑梗死并发全身炎症反应综合征和多脏器功能障碍综合征的临床研究

Clinical study of acute cerebral infarction complicating with systemic inflammatory response syndrome and multiple organ dysfunction syndrome

目的探讨急性脑梗死(ACI)诱发全身炎症反应综合征(SIRS)和多器官功能障碍综合征(MODS)的发病机制,以及C反应蛋白(CRP)在ACI诱发SIRS和MODS过程中的临床意义。方法94例ACI患者根据病情变化分为急性单纯脑梗死(SACI组)56例,ACI并SIRS(SIRS组)38例,ACI并发SIRS致MODS(MODS组)30例;应用Beckmanarray360特定蛋白分析仪的速率比浊法测定CRP,并与正常对照组30例比较。结果94例ACI中40.43%发生SIRS,SIRS时78.95%发生MODS;CRP阳性率各组与对照组比较,具有极显著性差异(P<0.01);CRP水平MODS组>SIRS组>SACI组>对照组,各组间比较具显著性差异(P<0.05)。结论ACI可诱发SIRS致MODS,炎症反应参与ACI发展过程,患者CRI水平可作为SIRS并发症的警报和治疗效果的判定指标。

Objective It is to discuss the pathogenesis of acute cerebral infarction （ACI） provocating systemic inflammatory response syndrome （SIRS） and multiple organ dysfunction syndrome （MODS）, and the clinical significance of C reactive protein （CRP） in the course of ACI provocating SIRS and MODS. Methods 94 patients with ACI were divided into simple ACI group （SCAI group, 56 cases）, ACI complicating SIRS group （SIRS group, 38 cases） and ACI complicating SIRS and MODS group （MODS group, 30 cases） according to their pathogenetic condition, CRP was measured with the Beckman array 360 definite protein analysator through the velocity turbidimetry, and the result was compared with normal control group（30 cases）. Results The incidence rate of SIRS in ACI was 40.43 % , the incidence rate of MODS in SIRS group was 78.95 %. There was significant difference in positive rate of CRP between every group and control group （ P 〈 0.01 ）. There was significant difference in the level of CRP among the groups （ P 〈 0.01 ）, MODS group 〉 SIRS group 〉 SACI group 〉control group. Conclusion ACI can provocate SIRS and MODS. Inflammatory response participate the course of ACI. The level of CRP can be used to predict the complication of SIRS and can be regard as the assessment index of the curative effect.