严重脓毒症患者血清血管内皮生长因子的临床研究

A clinical study of the serum vascular endothelial growth factor in patients with severe sepsis

目的检测严重脓毒症患者血清血管内皮生长因子（VEGF）水平的动态变化，探讨VEGF与急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及相关临床参数的关系。方法采用前瞻性随机对照研究，选择2006年7月－2007年10月本院重症监护病房（ICu）收治的29例严重脓毒症患者，检测发病后1、3、7d血小板计数（PLT）、白蛋白（Alb）水平，并计算APACHEI评分；采用酶联免疫吸附法（ELISA）检测血清VEGF水平，并按患者生存与死亡分为两组，比较两组的异同。以同期31例健康体检者作为健康对照组。结果健康对照组VEGF水平为（78．77±8．15）ng／L；生存组16例患者随时间延长VEGF水平逐渐下降（F=40．32，P〈0．01），7d时接近健康对照组（P〉0．05）；死亡组13例患者VEGF水平3d下降，7d又上升（F＝29．61，P〈0．01）。VEGF水平与APACHEⅡ评分呈显著正相关（r＝0．510，P＝0．000），与PLT呈显著负相关（r＝－0．221，P＝0．046），与A1b未显示相关性（r＝－0．029，P＝0．789）。结论严重脓毒症患者VEGF水平在发病早期明显升高，随病程进展生存组VEGF水平逐渐下降，死亡组下降不明显，VEGF在一定程度上反映脓毒症病情严重程度。

Objective To examine the dynamic changes in serum vascular endothelial growth factor （VEGF） levels in patients with severe sepsis, and to investigate its relationship with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score and some clinical parameters of patients. Methods Using prospective, randomly control study design, 29 patients with severe sepsis admitted to the intensive care unit （ICU） of the Second Hospital of Tianjin Medical University from July 2006 to October 2007 were enrolled for study. Platelet （PLT） count and albumin （Alb） levels on the 1st, 3rd, 7th day were determined, and APACHE Ⅱ score was assessed. VEGF levels of severe sepsis patients and healthy control volunteers （31 cases） were measured by enzyme linked immunoabsorbant assay （ELISA）. The patients were divided into two groups according to survival or death, and the differences between two groups were compared. Results The VEGF level in the health control group was （78. 77±8.15） ng/L. In 16 survivors, the VEGF levels gradually lowered along the course of the disease （F= 40. 32, P〈0. 01）. There was no statistical difference between control group and survival group on the 7th day （P〈0.05）. Thirteen patients died, and their VEGF levels lowered on the 3rd day, but elevated again on the 7th day （F=29.61, P〈0. 01）. The VEGF levels showed obvious positive correlation with APACHE Ⅱ score （r= 0. 510, P = 0. 000）, and negative correlation with PLT （r= 0. 221, P = 0. 046）, and no relation with Alb levels （r= 0. 029, P=0. 789）. Conclusion The VEGF levels are elevated at onset in severe sepsis patients. The VEGF levels lowered along with the course of the disease in survival group, but it lowers unconspicuously in death group. VEGF levels can reflect the severity of sepsis in certain degree.