红细胞膜磷脂酰丝氨酸外露在脓毒症患者贫血发生中的意义

Significance of erythrocytes phosphatidylserine exposure on occurrence of anemia in sepsis

目的探讨红细胞膜表面磷脂酰丝氨酸（Ps）外露在脓毒症患者贫血发生中的意义。方法采用自身前后对照研究方法，选择30例重症监护病房（ICU）脓毒症患者，分别在入ICU1d、7d时采集外周静脉血，常规测定血红蛋白（Hb）；采用膜联蛋白V／碘化丙啶（Annexin V／PI）染色方法，用流式细胞仪测定外周血中PS外露红细胞所占比例，分析Hb水平与Ps外露红细胞比例之间的相关性。结果30例脓毒症患者入ICU7d时的Hh水平较1d时显著下降（g／L：81．59±3．31比121．90±3．34，t=8．570，P=0．000）．外周血中PS外露的红细胞比例也明显高于1d时[（17．19±1．35）％比（7．87±0．83）％，t=-6．557，P=0．000]；Pearson直线相关分析显示，PS外露红细胞比例与Hb水平呈显著负相关（r=-0．838，P=0．000）。结论外周血Ps外露的红细胞在脓毒症患者中明显增加，且与患者贫血程度有关，贫血程度越严重，红细胞PS外露水平越高。

Objective To investigate the role of phosphatidylsefine （PS） exposure of erythrocytes in the development of anemia in sepsis patients. Methods A self-control study was conducted. Thirty sepsis patients admitted to intensive care unit （ICU） were enrolled. Peripheral venous blood was collected on I day and 7 days after ICU admission, and hemoglobin （Hb） concentration was examined routinely. A flow-cytometric assay based on Annexin V / propidium iodide （Annexin ~/PI） was used to measure the PS exposure of erythrocytes. The relationship between PS exposure and Hb concentration was analyzed. Results Hb concentrations in 30 sepsis patients at 7 days after ICU admission were significantly decreased compared with those of patients at 1 day （g/L： 81.59 ± 3.31 vs. 121.90 ± 3.34, t=8.570, P=0.000）, but the percentage of PS exposure of erythrocytes was significantly higher [（ 17.19 ± 1.35）% vs. （7.87 ± 0.83 ）%, t=-6.557, P=0.0001. An inverse correlation was found between percentage of PS-positive RBCs and Hb concentration by Pearson analysis （r=-0.838, P=0.000）. Conclusions The percentage of PS exposure in erythrocytes is significantly increased in sepsis, and it might contribute to the development of anemia in sepsis patients during hospital stay. The more severe the anemia, the higher the PS in erythrocytes.