脓毒症患者血浆可溶性颗粒膜蛋白CD62P的表达与凝血/纤溶功能关系研究

Correlation between the changes of plasma soluble CD62P level and coagulation/fibrinolysis in the patient with sepsis

目的探讨脓毒症(Sepsis)患者血浆可溶性颗粒膜蛋白CD62P(s-CD62P)的表达及其与凝血/纤溶指标的关系。方法以ICU住院治疗的70例患者为研究对象,分为Sepsis组38例、全身炎症反应综合征(System-ic Inflammatory Response Syndrome,SIRS)组32例,另选取健康体检者20例作为正常对照组。分别检测其入住ICU后24h内的s-CD62P、血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-dimer)和抗凝血酶Ⅲ活性(AT-Ⅲ),并分别进行CD62P与上述凝血/纤溶指标的相关分析。结果①与正常对照组和SIRS组比较,Sepsis组s-CD62P水平明显升高(P<0.05);②与正常对照组比较,Sepsis组和SIRS组D-dimer、PT、APTT均显著升高,而PLT计数、AT-Ⅲ活性显著降低(P<0.05);③s-CD62P水平与D-dimer、PT和APTT明显正相关,而与PLT计数、AT-Ⅲ活性呈明显负相关(P<0.05)。结论脓毒症患者血浆s-CD62P水平明显升高,发生凝血/纤溶功能障碍较为常见;s-CD62P不仅是血小板活化的标志物,也是脓毒症炎症反应与凝血/纤溶功能障碍发生和发展的重要始动因素。

Objective To observe the expression of plasma soluble CD62P in sepsis patients and analyze relationship between coagulation/fibrinolysis and s-CD62P.Methods 70 critically ill patients were admitted in ICU of the Affiliated Hospital.According to diagnostic criteria of Sepsis/SIRS,the patients were divided into Sepsis group（n=38） and SIRS group（n=32）,and healthy volunteers（n=20） were considered as control group.Parameters of coagulation/fibrinolysis such as PLT,PT,APTT,D-dimer and AT-Ⅲand s-CD62P were measured and analyzed within 24h admission in ICU and SOFA score of critically ill was evaluated.The relation between coagulation/fibrinolysis and s-CD62P were executed statistical analysis respectively.Results Compared with control group and SIRS group the level of s-CD62P was significantly higher in patients of sepsis group（P0.05）;Compared with the control group,the level of D-dimer,PT,APTT were higher in sepsis group and SIRS group,while platelet count（PLT）,the activity of AT-Ⅲ were obviously lower（P0.05）;The s-CD62P level was positively correlated with TNF-α,hs-CRP,D-dimer,PT,APTT,whereas negatively correlated with PLT,AT-Ⅲ（P0.05）.Conclusion The plasma s-CD62P concentration is higher in patients with sepsis,and there are dysfunctions of coagulation/fibrinolysis in patients with sepsis too.The s-CD62P is the marker of platelet activation.It is important initial factor of the occurrence and development of coagulation/fibrinolysis and sepsis/SIRS.