严重外科感染患者杀菌/通透性增加蛋白水平的变化规律及意义

Significance of changes in plasma bactericidal/permeability-increasing protein levels in patients with severe surgical infection

目的观察外科严重感染患者内源性杀菌/通透性增加蛋白(BPI)的变化规律及其临床意义。方法筛选外科严重感染患者19例,分别于感染前和感染后第1、3、5、7、14天采集血标本。采用 ELISA 方法测定血浆 BPI、脂多糖结合蛋白(LBP)和白细胞介素-6(IL-6)水平;内毒素含量采用改良基质显色法鲎试验检测。同时检查感染前及感染后第1、3、5、7、14天的中性粒细胞计数,并观察患者预后。结果与正常对照组比较,脓毒症组患者感染后第1～5天血浆中 BPI/LBP 比值明显降低(P<0.01),第7天恢复至正常范围;严重脓毒症组患者感染后第1～7天其比值显著降低(P<0.01)。此外,感染后第1～3天严重脓毒症组血浆中 BPI/LBP 比值显著低于脓毒症组(P<0.05)。结论外科感染时机体内源性 BPI 和 LBP 水平迅速升高,但 BPI 的增幅明显低于 LBP;感染早期BPI/LBP 比值与脓毒症病情的严重程度密切相关。

Objective To investigate changes in endogenous bactericidal/permeability-increasing protein （ BPI ） levels and their significance in patients with surgical sepsis. Methods In the prospective study, 19 surgical patients with infection were involved. The plasma BPI, lipopolysaccharide-binding protein （LBP） and interleukin-6 levels were measured on post-infected days 1, 3, 5,7 and 14 by an enzyme-linked immunosorbent assay （ELISA）. Plasma endotoxin concentrations were determined by the modified chromogenic Limulus Amebecyte Lysate （LAL）. Results Compared with normal controls, significant lower plasma BPI/LBP ratios were observed in septic patients on days 1 to 5 after infection （ P 〈 O. O1 ）, and in severe septic patients on days 1 to 7 （ P 〈 O. O1 ）. Moreover, plasma BPI/LBP ratios were much lower in severe sepsis than those in sepsis on days 1 to 3 after infection （ P 〈 O. 05 ）. Condusions Plasma BPI and LBP levels increased rapidly after infection, hut BPI/LBP ratios were significantly decreased during sepsis. Plasma BPI/LBP ratios appear to be closely related to the severity of sepsis in patients complicated by surgical infection.