全身炎症反应综合征患者血浆乳酸水平与炎症反应的相关性研究

Correlative study between plasma lactate concentration and inflammatory reaction in patients with systemic inflammatory response syndrome

目的研究全身炎症反应综合征(SIRS)患者急性期反应以及血浆乳酸水平与炎症反应标志物C-反应蛋白(CRP)、内毒素浓度的相关性。方法符合SIRS诊断32例于入院时、入院后第2和5天早晨空腹抽取肘静脉血8ml,应用氧化酶法在日立全自动生化分析仪上进行测定血浆乳酸,速率散射免疫比浊法测定CRP和基质偶氮显色鲎试验测定法测定内毒素浓度,并设健康对照组。结果血浆乳酸水平、CRP水平和内毒素浓度在时相监测点均同步升高,与对照组比较差异有统计学意义(P均<0.01);血浆乳酸水平与CRP浓度、内毒素含量呈正相关(P<0.01);器官功能不全组患者血浆乳酸水平、CRP水平和内毒素浓度高于器官功能正常组患者(P<0.05)。结论 SIRS患者炎症急性期反应时,具有直接或间接作用使血浆乳酸水平增高,同时乳酸水平增高也有可能加重炎症反应。因此,监测SIRS患者血浆乳酸水平,能反映炎症反应的程度,是判断治疗效果和预后的有效措施。

Objective To investigate the relationship between concentration of plasma lactate, serum C-reactive protein （CRP） and plasma endotoxin in patients with systemic inflammatory response syndrome （SIRS）. Methods A total of 32 patients with confirmed diagnosis of SIRS were enrolled in this study. Venous blood samples were collected on the mornings of 1st, 2nd and 5th d after admission. Plasma lactate was determined by enzymatic measurement. Serum CRP and plasma endotoxin were also measured at the same monitoring sites. Blood samples from health people were selected as control group. Results Levels of plasma lactate, serum CRP and plasma endotoxin increased synchronously at the monitoring sites, which had the significant difference compared with the control group （P〈0.O1）. The changes of plasma lactate concentration, serum CRP and plasma endotoxin were in significantly positive correlation （P〈0.01）, and increased remarkably in the patients with organ dysfuction （P〈0.05）. Conclusions The concentration of plasma lactate elevates in acute inflammatory reaction of SIRS. And the high concentration of plasma lactate may possibly worsen the processes of inflammatory reaction. So the level of plasma lactate can effectively predict the severity and prognosis of SIRS.