重症患者早期血清基质金属蛋白酶-9、可溶性P-选择素测定的临床意义

Clinical significance of the concentration of matrix metalloproteinases-9 and soluble P-selections in early critically ill patients

目的探讨早期检测血清基质金属蛋白酶-9(MMP-9)、可溶性P-选择素(sP-选择素)预测重症患者脓毒症(Sepsis)发生的临床意义。方法根据脓毒症及全身炎症反应综合征(SIRS)诊断标准,将104例重症患者分成三组,即A组(Sepsis组)44例,B组(SIRS组)36例,C组(非SIRS组)24例。检测患者转入ICU后2h内血清MMP-9、sP-选择素浓度及临床指标。结果①A、B、C组患者MMP-9平均水平依次为(6.46±0.58)mg/L、(6.01±0.71)mg/L、(5.22±0.73)mg/L,组间比较差异均有统计学意义(P<0.01)。②A、B组患者血清sP-选择素水平(2.40±1.98)mg/L、(2.11±1.50)mg/L显著高于C组患者(1.25±0.82)mg/L,差异有统计学意义(P<0.01)。③对影响患者病情严重程度的危险因素进行多元有序Logistic回归显示,MMP-9指标进入回归方程(P<0.01)。④ROC曲线分析显示早期测定MMP-9水平对判定重症患者脓毒症发生与否的曲线下面积达0.780(P<0.01)。结论 MMP-9、sP-选择素参与重症患者全身炎症反应启动和脓毒症的发生,早期MMP-9水平测定对于脓毒症发生的识别、病情判断具有一定的临床价值。

Objective To study the expression of serum matrix metalloproteinase-9（MMP-9）,soluble P-selections（sP-selections） and to predict the clinical significance in diagnosis of critically ills with sepsis.Methods 104 patients with critically ill were admitted in ICU were divided into group A（sepsis,n=44）,group B（SIRS,n=36） and group C（non-SIRS,n=24）.The MMP-9 and sP-selections in serum of patients were measured within 2h admission in ICU.Results The average level of MMP-9 in group A,B,C were respectively 6.46 ± 0.58 mg/L,6.01 ± 0.71 mg/L,5.22 ± 0.73 mg/L and there were significantly different（P0.01）.The average level of sP-selections in group A,B（2.40±1.98mg/L,2.11±1.50mg/L） was significantly higher than that in group C（1.25±0.82mg/L）（P0.01）.Ordered multiple logistic regression on disease severity showed that MMP-9 indicator was into the regression equation（P0.01）.ROC analysis showed that early MMP-9 levels of patients that area under the curve which was 0.780（P0.01）.Conclusion MMP-9 and sP-selections may significantly impact on the pathological process of systemic inflammatory response syndrome and sepsis.The early measurement of MMP-9 is helpful in the identification of sepsis and to determine disease severity of critically ills.