胡蜂蜇伤患者早期血清钙非依赖磷脂酶 A2水平的变化及其临床研究

Clinical study of the changes of serum calcium-independent phospholipase A2 of wasp stings patients

目的：探讨秦巴山区胡蜂蜇伤患者血清钙非依赖磷脂酶A2（iPLA2）水平的变化及其临床意义。方法将34例来我院就诊的胡蜂蜇伤患者，依据实验室检查分为非溶血组、溶血组，采集血清备用；另以10例健康体检者血清作为正常对照组。依据实验室检查和临床指征，比较非溶血组、溶血组患者多器官功能障碍综合征（MODS）的发生情况。采用酶联免疫吸附测定法（ELISA）检测血清 iPLA2、前列腺素 E2（PGE2）和血栓素 A2（TXA2）水平，各组之间比较并进行统计学分析。结果溶血组患者发生MODS比例明显高于非溶血组（16/19 vs.5/15，P＜0.01）。胡蜂蜇伤患者血清TXA2水平均明显高于正常对照组（P＜0.01）；溶血组TXA2水平高于胡蜂蜇伤非溶血组患者，但差异无统计学意义（P＞0.05）。溶血组患者血清 PGE2水平明显高于非溶血组患者（P＜0.01）。溶血组患者血清iPLA2水平明显高于胡蜂蜇伤非溶血组和正常对照组（P＜0.01）。胡蜂蜇伤患者iPLA2水平与PGE2水平呈正相关（r＝0.867，P＝0.000），也与TXA2水平呈正相关（r＝0.543，P＝0.004）。结论胡蜂蜇伤患者发生溶血是引起MODS重要因素之一。胡蜂蜇伤溶血患者血清iPLA2明显升高，它可能参与胡蜂蜇伤重症患者MODS的发生、发展，动态监测iPLA2水平的变化，可以评估患者病情、指导治疗及帮助判断患者的预后。

Objective To explore the changes and manifestations of serum calcium-indepen-dent phospholipase A2（iPLA2）of wasp stings patients. Methods According to the laboratory examina-tions, 34 wasp stings patients were divided into two groups： non-hemolytic group and hemolytic group. Serum of patients was isolated for preparation. Another 10 samples of healthy persons were included in the normal control group. On the basis of laboratory examination and clinical indications, the incidence of multiple organ dysfunction syndrome（MODS）was compared between non-hemolytic group and hemo-lytic group. The serum levels of iPLA2, prostaglandin E2（PGE2）and thromboxane A2（TXA2）were de-terminated by enzyme-linked immunosorbent assay（ELISA）. Finally, we compared the difference be- tween each group and analyzed the results with statistical methods. Results The proportion of MODS in patients with hemolytic group was significantly higher than that in non-hemolytic group（16/19 vs 5/15, P〈0.01）. The serum TXA2 of wasp stings patients was significantly higher than that in normal con-trol group（P〈0.01）. Serum TXA2 in hemolytic group was higher than that in non-hemolytic group, but there was no significant difference between the two groups（P〉0.05）. Serum PGE2 in hemolytic group was significantly higher than that in non-hemolytic group（P〈0.01）. Serum iPLA2 in hemolytic group was significantly higher than that in non-hemolytic group and in normal control group（P〈0.01）. Serum iPLA2 level in wasp stings patients was positively correlated with the serum level of PGE2（r = 0.867, P =0.000）, and was also positively correlated with the serum level of TXA2（r = 0.543, P =0.004）. Con-clusion Hemolysis is an important factor to cause MODS in wasp stings patients. The levels of serum iPLA2 increase significantly in wasp stings patients with hemolysis, suggesting that iPLA2 may be in-volved in the occurrence and development of MODS in wasp stings patients. Dynamic monitoring of iPLA2 levels can assess the patient＆#39;s condition, and guide the treatment of wasp stings patients, and help to judge the prognosis of patients.