vWF和ADAMTS13活性对脓毒症患者早期预后评估的意义

vWF and ADAMTS13 activity in early prognosis assessment for patients with sepsis

目的本研究旨在研究和探讨血管性血友病因子（von Willebrand factor，vwF）和含Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶（A disintegrin—like and metalloprotease with thrombospondin type 1 motif，vWF裂解酶，ADAMTS13）的活性在感染性休克和脓毒症患者早期及预后评估方面的临床意义。方法选取2012—06—2013—06收住无锡市人民医院ICU的感染性休克或脓毒症患者40例，根据预后分为存活组20例和死亡组20例，记录其一般情况及入组时APACHE11评分，于发病第1、3、5、7天分别运用ELISA法检测其血浆vWF活性及ADAMTS13活性，各样本均数用方差分析、受试者工作特征（receiver operating characteristic，ROC）曲线分析、参数间进行Spearman相关分析，并绘制ROC曲线探讨vWF活性、ADAMTS13活性与APACHE Ⅱ评分之间的相关性。结果死亡组的vWF活性均明显高于存活组（P〈0．05），ADAMTS13活性明显低于存活组（P〈0．05）；同时死亡组APACHEⅡ评分明显高于存活组（P〈0．05）；存活组在第3天vwF活性升高、ADAMTS13活性下降、APACHEⅡ评分升高，而在第5天和第7天又出现vWF活性持续下降、ADAMTS13活性持续升高、APACHEⅡ评分持续下降，死亡组则呈现vWF活性持续上升、ADAMTS13活性持续下降、APACHEⅡ评分持续升高（P〈0．05）。40例患者的平均vWF活性与APACHEⅡ评分呈正相关（P〈0．01），而ADAMTS13活性与APACHEⅡ评分呈负相关（P〈0．01）：ROC曲线分析，vWF活性和ADAMTS13活性AUC均接近于1，提示能很好地预测患者的预后（P〈0．01）。结论vWF活性、ADAMTS13活性均是判断感染性休克和脓毒症患者预后的可靠指标。在脓毒症的病理过程中，此二者数值的变化与疾病严重程度密切相关，即vWF活性的升高、ADAMTS13活性的降低预示了患者预后差。

Objective This study aims to investigate the clinical roles of von Willebrand factor （vWF） and a disintegrin - like and metalloprotease with thrombospondin type 1 motif （ vWF cleaving protease, namely vWF- CP, ADAMTS13 ） in early prognosis assessment to patients with sepsis and septic shock. Methods Forty patients with septic shock or sepsis treated in ICU of Wuxi People＇s hospital from June 2012 to June 2013 were enrolled. They were divided into the survival group and death group according to the prognosis, with 20 patients in each group. General information and APACHE Ⅱ score at baseline were recorded. Then ELISA method was used to detect the activity of plasma vWF and ADAMTS13 on 1, 3, 5, and 7 days after the onset, respectively. The mean value of each sample was analyzed through variance analysis, receiver operating characteristic （ROC） curve and Spearman correlation analysis between parameters. ROC curve was drawn to explore the correlation between the activity of vWF activity and ADAMTS13 with the APACHE iI score. Results vWF activity in death group was significantly higher than that of survival group （P 〈0.05 ）, whereas the ADAMTS13 activity in death group was significantly lower than that of the survival group （ P 〈 0.05 ） ; at the same time, APACHE Ⅱ score in death group was significantly higher than that in survival group （ P 〈 0.05 ） ; for survival group, on the 3th day, vWF activity and APACHE Ⅱ scores were increased while ADAMTS13 activity was declined; whereas on the 5th and 7th days, vWF activity and APACHE Ⅱ score were appeared to be continuously declined, while ADAMTS13 activity was continuously increased; for death group, vWF activity and APACHE Ⅱ were rising, while ADAMTS13 activity was continuously decreased （P 〈 0. 05 ）. Average activity of vWF and APACHE Ⅱ scores were positively correlated in the 40 patients （P 〈 0.01 ） , while ADAMTS13 activity was negatively correlated with APACHE Ⅱ score （P 〈 0.01 ）. Seen from the ROC curve analysis, AUC of vWF activity and ADAMTS13 activity was both close to 1, showing that they can well predict the prognosis of patients （P 〈 0. 01 ）. Conclusion vWF and ADAMTS13 activities were reliability indexes to judge the prognosis of patients with sepsis or septic shock. In the pathological process of sepsis, the changes of these two values were closely related to the severity of disease, namely, the rise of vWF activity and the decline of ADAMTS13 activity may indicate the poor prognosis.