腹腔感染合并腹内高压患者血浆Apelin水平的变化

The change of plasma Apelin concentration in patients of abdominal infection with intra-abdominal hypertension

目的探讨腹腔感染并腹腔内高压（IAH）患者血浆Apelin水平变化及其与腹腔内压力（IAP）的关系。方法选择2008年7月至2012年5月本院重症医学科收治的成人腹腔感染患者43例，根据lAP分为单纯腹腔感染（OIN）组9例，IAH组18例及腹腔间隔室综合征（ACS）组16例，以同期17例健康志愿者为健康对照组。检测患者入住重症监护病房（ICU）时血浆Apelin、降钙素原（PCT）、C-反应蛋白（CRP）、N末端脑钠肽前体（NF—proBNP）、血小板计数（PIJT）、白细胞计数（WBC）、血乳酸（Lac）、血浆白蛋白（Alb）、出凝血指标、肌酐（cr）和IAP水平；将患者再按是否行腹腔减压术分为非手术组（12例）及手术组（31例）。于术前及术后1、3、5d经肘静脉取血，采用放射免疫法（RIA）测定血浆Apelin水平，并观察血浆Apelin与IAP水平的相关性。结果①与健康对照组比较，OIN组、IAH组、ACS组性别、年龄比较差异均无统计学意义（均P〉0．05）；3组CRP（rag／L）、PCT（~g／L）、Lac（mmol／L）、Apelin（ng／L）、NT—proBNP（ng／L）、凝血酶原时间（PT，S）、活化部分凝血活酶时间（APlT，S）、Cr（txmol／L）、lAP（mmHg，lmmHg=0．133kPa）均升高，以ACS组升高更显著（CRP：18．4±2．2比6．4±1．5，PCT：14．2±9．7比0．2±0．1。Lac：2-3±0．8比1．5±0．6，Apelin：148．3±34．9比57．1±28．3，NT—proBNP：934．5±320.3比596．7±240．7，PT：19．7±9．1比13．6±0．5，APlTr：58．2±29．7比33．6±8．4，Cr：148．4±39．5比77．9±21-3，IAP：24．8±4．2比3．9±1．6，P〈0．05或P〈0．01）；OIN组和IAH组WBC均升高，ACS组降低（13．3±0-3、16．7±0．5、1．0±0．8比5．9±0．6，均P〈0．01）；3组PIJ，r（×10’／L）、血浆Alb（g／L）水平均降低，以ACS组降低更显著（PlJT：99．7±34．7比196．2±40．1，Alb：24．8±10-3比39．1±11．4，均尸〈0．05）。②术后3d、5d，手术组Apelin水平（ng／L）均较非手术组明显降低，以术后3d下降更快（88-3±27．6比103．8±29．1，P〈0．01）。③患者血浆Apelin水平与IAP水平呈显著正相关（r=0．585，P〈0．05）。结论腹腔感染患者血浆Apelin水平升高，以ACS升高明显，腹腔减压后，血浆Apelin浓度下降，其水平与腹腔灌注压呈正相关。提示Apelin参与腹腔感染基础上的IAH及ACS的病理生理过程，有一定的临床意义。

Objective To evaluate the change of plasma Apelin in patients of abdominal infection with intra-abdominal hypertension （IAH） and the relationship between Apelin plasma concentration and intra-abdominal pressure （IAP）. Methods According to the level of IAP, 43 patients with intra-abdominal infection in department of critical care medicine from July 2008 to May 2012 were divided into only intra-abdominal infection （OIN） group （9 cases ）, IAH group （ 18 cases） and abdominal compartment syndrome （ACS） group （ 16 cases ） ; 17 volunteers in the corresponding period were enrolled as the healthy control group in the study. The levels of plasma Apelin, procalcitonin （PCT）, C-reactive protein （CRP）, N-terminal pro-brain natriuretie peptide （NT-proBNP）, platelet count （PLT）, white blood cell （WBC） count, blood lactate （Lac）, plasma albumin （Alb）, coagulation parameters, creatinine （Cr） and lAP were monitored when the patients were admitted into intensive care unit （ICU）. According to whether the patient was necessary to perform the abdominal decompression operation, the patients were divided into no operation group （12 cases） and operation group （31 cases） . The blood was collected from the ulnar vein before operation and 1,3,5 days after operation. The concentrations of plasma Apelin were measured by radioimmunoassay （RIA） . The correlation between the concentration of plasma Apelin and the level of lAP was evaluated. Results （~） There were no differences in sex and age in OIN, IAH and ACS group compared with the healthy control group （all P 〉 0.05）; the CRP （rag/L）, PCT （txg/L）, Lac （mmol/L）, Apelin （ng/L）, NT-proBNP （ng/L）, prothrombin time （PT, s）, activated partial thromboplastin time （APTT, s）, Cr （~tmol/L）, IAP （mm Hg, 1 mm Hg=0.133 kPa）in OIN, IAH and ACS groups were significantly increased, especially in ACS group （CRP ： 18.4±2.2 vs. 6.4＋ 1.5, PCT ： 14.2 ＋ 9.7 vs. 0.2 ＋ 0.1, Lac ： 2.3 ± 0.8 vs.l.5 ＋ 0.6, Apelin ： 148.3 ＋ 34.9 vs. 57.1 ＋ 28.3, NT-proBNP ： 934.5 ＋ 320.3 vs. 596.7＋240.7, PT ： 19.7＋9.1 vs. 13.6＋0.5, APTT ： 58.2＋29.7 vs. 33.6＋8.4, Cr ： 148.4＋39.5 vs. 77.9＋21.3, IAP ： 24.8± 4.2 vs. 3.9± 1.6, P〈 0.05 or P〈 0.01 ） ; the levels of WBC were increased in OIN and IAH groups, but the level was reduced in ACS group compared with that in the healthy control group （13.3 ＋ 0.3,16.7±0.5,1.0± 0.8 vs. 5.9 ＋ 0.6, all P 〈 0.01 ） ; the PLT （ ~ 109/,） and plasma Alb （g/L） were reduced in OIN, IAH and ACS groups compared with those in healthy control group, especially in ACS group （PLT ：99.7±34.7 vs. 196.2___40.1, Alb ： 24.8 ＋ 10.3 vs. 39.1 ＋ 11.4, both P 〈 0.05）. ~） Three days and 5 days after abdominal decompression operation,the level of plasma Apelin （ng/L）in operation group was significantly reduced compared with that of no operation group, and the reduction was more prominent on the 3rd day ＇after the operation （88.3±27.6 vs. 103.8±29.1, P〈 0.01）. The plasma Apclin concentration in patients of abdominal infection was significantly positively correlated with the level of IAP （r=0.585, P〈0.05）. Conclusions The level of plasma Apelin is elevated in patients with intra-abdominal infection, especially prominent in patients with ACS, and after abdominal decompression operation, its plasma level is lowered and positively correlated with the height of 1AH, suggesting that Apelin might be involved in the patho-physiological process in IAH and ACS on the basis of abdominal infection and have certain clinical significance.