严重脓毒症目标血糖管理下P-选择素变化的临床意义

The study of changes and clinical significance of p - selectin in target glucose control therapy for serious septic patients

目的探讨严重脓毒症目标血糖管理过程中P一选择素（CD62p）浓度的动态变化及其临床意义。方法将45例严重脓毒症患者随机分为：A组23例（目标血糖控制在4．1．6．1mmol／L）；B组22例（目标血糖控制在6．2～8．3mmol／L）。在入院时就给予目标血糖控制，分别在第0、8、12、24及72小时采集静脉血，用ELISA法检测CD62p浓度，用生化仪测定血小板计数（PLT）、血浆凝血酶原时间（盯）、活化的部分凝血活酶时间（APIrr）及纤维蛋白原（FIB）的变化；相同时间点观察急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分，并计算28d病死率。另外，根据28d生存情况将患者分为死亡组和存活组进行对比分析。结果A、B两组随着治疗时间的延长，CD62p浓度及APACHEH评分均下降，治疗第24、72小时与入院时比较差异有统计学意义（P均〈0．05）；治疗第72小时A组CD62p浓度及APACHEⅡ评分均低于B组（P均〈0．05）。28d病死率：A组21．74％（5／23）与B组27．27％（6／22）比较降低，但差异无统计学意义（P〉0．05）。两组治疗前后PT、APTr、FIB和PLT差异均无统计学意义（P〉0．05）。死亡组CD62p浓度及APACHEH评分均明显高于存活组，差异有统计学意义（P〈0．05）。脓毒症患者入院时CD62p浓度与APACHEH评分呈正相关（r=0．734，P〈0．01）。结论严重脓毒症患者在目标血糖管理下，能显著抑制CD62p浓度、降低病死率和改善预后，CD62p有望成为判断脓毒症病情严重程度和预后的良好指标。

Objective To Explore the dynamic changes and clinical significance of the p - selectin （CD62p） in target glucose control therapy for serious septic patients. Methods 45 serious septic patients were randomly divided into two groups： target glucose control A group 23 cases （glucose control in 4.1 - 6.1 mmol/L） and target glucose control B group 22 cases （ blood glucose control in 6.2 - 8.3 mmol/L）, in admitted cases were given target glucose control, Enzyme linked immunosorbent assay（ELISA） was used in the detection of CD62p in 0 h, 8 h, 12 h, 24 h, and 72 h in all patients with serious septic patients, with biochemical instrument determination levels of platelet （ PLT）, and prothrombin time （ PT）, activated partial thromboplastin time （ APTF ） and fibrinogen （ FIB ）, and observing Score of acute physiology and chronic health evaluation II （ APACHE 1I ） and record 28 d mortality. Also survival under 28 d divides patients into death unit （ 11 cases） and survival set （ 33 cases） comparative analysis. Results Both APACHE 1I and CD62p levels in A and B group decreased with passage of time, the differences were significant between the results in 24 h, 72 h comparison of treatment on admission （ both P 〈0.05 ）. In the A group, APACHE 11 and CD62p levels decreased, and they were lower than those in B group 72 h after treatment （ both P 〈 0.05 ）. The mortality rate in 28days also lowered[21.74% vs. 27.27% ] in A group, but the difference was not significant （P 〉 0.05）. Death group CD62p and APACHE II scores significantly are higher than survival group, the difference with statistically significant＇-＇ （P 〈 0. 05 ）. Admission in patients with sepsis CD62p, APACHE 11 scores is positive （ r = 0.734, P 〈 0.01 ）. Conclusion target glucose control management can significantly suppress the expression of CD62p, lower fatality rate, P - selectin is expected to become a good indicator to determine the sepsis severity and prognosis.