P-选择素在危重病患者心肌损伤中的作用

A clinical study on P-selectins role in critically ill patients with myocardial injury

目的 :本课题对综合性重症监护病房患者的心肌损伤进行研究 ,旨在探讨危重病患者心肌损伤的可能机制。方法 :利用心肌肌钙蛋白T和P 选择素两项指标测定 ,对综合性重症监护病房内 1 5例APACHEⅡ≥ 1 6危重病患者和 2 0例健康献血员进行对比研究。结果 :①危重病患者心肌肌钙蛋白T浓度明显高于健康献血员 ,且其中死亡组又明显高于存活组 (P <0 0 1或P <0 0 5) ;②危重病患者的P 选择素在发病后 4、 2 4、 1 2 0h 3个时点均显著高于献血员 (P<0 0 1 ) ,死亡组危重病患者P 选择素浓度在发病 2 4h达峰值且显著高于存活组患者 (P <0 0 5) ;③在危重病患者发病后第 4、 2 4hcTnT与P 选择素两者呈显著正相关 (γ4=0 73 48,P <0 0 1 ;γ2 4 =0 6865,P <0 0 1 )。结论 :①在危重病患者中存在急性心肌损伤 ,且心肌损伤程度与患者的预后相关 ;②P 选择素在危重病患者心肌损伤的发生发展过程中起了重要作用。

Aim:The myocardial injury in critically ill patients in general ICU were studied to explore the mechanism of the myocardial injury.Methods:The serum cardiac troponin T and P selectin levels of 15 critically ill patients (APACHE Ⅱ≥16)and that of 20 normal blood donors were compared with each other.Results:①The cardiac troponin T levels of critically ill patients were significantly higher than that of donors whereas in critically ill patients serum cardiac troponin T and P selectin levels were also significantly higher in the death group than those of the survival group(P<0 01 or P<0 05);②The P selectin levels of the critically ill patients were significantly higher than that of the donors at 4,24,and 120 hours after onset of the diseases (P<0 01),whereas P selectin levels of the death group reached its peak and were significantly higher than that of the survival group at 24 hours after onset of the diseases(P<0 05);③There were significant positive relations between cardiac troponin T and P selectin at 4、24 hours after onset of the diseases (γ 4=0 7348 P<0 01,γ 24 =0 6865 P<0 01).Conclusion:①There was myocardial injury in critically ill patients which could be used to determine the prognosis;②P selectin may play an important role in the pathophysiological process of myocardical injury in the critically ill patients.