严重脓毒症致ARDS患者血浆MMP-9和TFC的变化及乌司他丁干预效果的研究

The changes of MMP-9 concentration and TFC level in patients with ARDS caused by sever sepsis and the intervention effect of ulinastatin

目的:动态观察严重脓毒症致急性呼吸窘迫综合征(ARDS)患者血浆基质金属蛋白酶-9(MMP-9)的浓度和胸腔液体水平(TFC),通过对照研究给予乌司他丁注射液(UTI),观察干预前后严重脓毒症患者血浆MMP-9的浓度及TFC的变化。方法:选择符合严重脓毒症致ARDS诊断标准的58例患者作为研究对象,按照随机原则分为UTI组(n=30例)和对照组(n=28例),2组均给予常规综合治疗,UTI组在此基础上加用UTI 30万U静脉滴注,1/6h,连用3d,观察治疗前后患者的血清MMP-9浓度、TFC、氧合指数(PaO2/FiO2)、Murray肺损伤评分以及28d病死率。结果:2组患者均出现血清MMP-9浓度升高及TFC增多,治疗后UTI组患者PaO2/FiO2较对照组显著升高(P<0.05),且TFC、MMP-9浓度及28d病死率均较对照组显著降低(P<0.05)。结论:UTI能够降低严重脓毒症致ARDS患者血浆MMP-9及TFC,从而改善患者临床症状。

Objective：To investigate the relevance between serum MMP-9concentration and thoracic fluid content level in patients with acute respiratory distress syndrome dynamically,and the therapeutic effect of ulinastatin injection.Method：Fifty-eight patients with ARDS were identified and grouped into intoulinastatin injection（UTI）treatment group（n=30cases）and control group（n=28cases）randomly.Two groups were given conventional treatment,UTI treatment group based on the use of UTI 1/6h300,000 Uintravenous drip,QD for 3days.Thoracic fluid content level,stroke volume,serum MMP-9level,PaO2/FiO2 were tested every day in the first 4days.Murray score,APACHEⅡ score,SOFA score were analyzed at the same check point.Result：Fifty-eight patients were identified,and all had an increase of serum MMP-9concentration and elevated TFC at various degree.At the end of the treatment,the UTI treatment group,PaO2/FiO2 increased significantly compared with control group（P〈0.05）.TFC and MMP-9decreased significantly and the 28 day mortality decreased significantly compared with control group（P〈0.05）.Conclusion：ARDS patients were associated with different levels of increased MMP-9concentration and TFC level.Ulinastatin can reduce the serum MMP-9concentration and TFC level,which can improve the clinical symptoms.