脓毒症患者妊娠相关血浆蛋白A水平的变化和意义

Alteration of pregnancy-associated plasma protein A in patients with sepsis and its significance

目的探讨脓毒症患者循环血中妊娠相关血浆蛋白A（PAPPA）水平的变化和临床意义。方法选择59例符合脓毒症诊断标准的患者和52例性别、年龄相当、具有同类基础疾病的非脓毒症ICU患者（对照组）。抽取其静脉血测定PAPPA、前降钙素原（PCT）、B型钠尿肽（BNP）、心脏肌钙蛋白1（cTnl）和肌酸激酶同工酶MB（CK—MB）水平等指标，比较其急性生理和慢性健康评分（Apachell），并将PAPPA水平与PCT、BNP、cTnl、CK—MB水平及Apachell评分作相关性分析。结果脓毒症患者PAPPA、PCT、cTnl和BNP水平较对照组明显增高（均P〈0.01），Apachell评分明显高于对照组（P〈0.01）；PAPPA水平与BNP水平、Apachell评分、PCT和cTnl呈显著正相关（均P〈0.01），与CK—MB无相关性（P〉0.05）。结论脓毒症患者血液中PAPPA水平增高与患者病情严重程度有关，PAPPA可望作为判断脓毒症患者心肌抑制和心功能不全的生化标志物。

Objective To investigate the alteration and significance of circulating pregnancy-associated plasma protein A （PAPPA）in septic patients. Methods Fifty-nine patients with sepsis and 52 non-septic ICU patients with matched age, gender and underlying diseases （control） were enrolled. The levels of circulating PAPPA, procalcitonin （PCT）, B-type natriuretic peptide （BNP）, cardiac troponin I （cTnl） and creatine kinase isoenzyme MB （CK-MB） were detected, and the acute physiological and chronic health evolution Ⅱ （Apache Ⅱ） score was calculated and compared between two groups. Correlation analysis was carried out between PAPPA levels and levels of PCT, BNP, cTnl, CK-MB and Apachell score. Results In comparison with control, PAPPA, PCT, cTnl and BNP levels in septic patients were significantly increased （all P〈0.01）, and the Apache II score was significantly higher than that of control （P〈0.01）. The PAPPA level was positively correlated with levels of BNP, PCT, cTnl and Apache Ⅱ score （all P〈0.01）; there was no significant correlation between PAPPA and CK-MB （P〉0.05）. Conclusion Increased circulating PAPPA levels in septic patients are associated with the severity of the disease, which indicates that PAPPA can serve as a biomarker for determining myocardial depression and cardiac dysfunction in sepsis.