脓毒症患者外周血TNF-α、HMGB-1、TF和vWF动态变化及临床意义

Clinical significance of dynamic detecting TNF-α,HMBG-1,TF and v WF in peripheral blood from patients with sepsis

目的探讨动态监测脓毒症患者外周血中TNF-α、HMGB-1、TF和v WF的临床意义。方法收集入院24、48、72和120 h脓毒症患者39例及15例正常人外周血,采用ELISA法检测血清TNF-α、HMGB-1、TF和血浆v WF水平。把脓毒症患者分为死亡和存活组,比较不同时间外周血中TNF-α、HMGB-1、TF和v WF水平变化与脓毒症严重程度之间的关系。结果脓毒症患者不同时间外周血TNF-α、HMGB-1、TF和v WF水平均显著高于正常人(P<0.01)。经Logistic回归分析,死亡组显著高于存活组患者,且差异有统计学意义(P<0.05)。受试者工作曲线分析该四炎症因子均以72、120 h曲线有明显判断价值。结论从Logistic回归分析和受试者工作曲线分析得出TNF-α、HMGB-1、TF和v WF水平变化与脓毒症患者病情及病程正相关,以72 h和120 h曲线有参考价值。

Objective To investigate the clinical significance of dynamic detecting the levels of TNF-α, HMBG-1, TF and vWF in the peripheral blood from the patients with sepsis. Method The serum and plasma were collected from 39 patients with sepsis onset 24, 48, 72 and 120 h, and 15 health volunteers. The levels of TNF-α, HMBG-1, TF in serum and vWF in plasma were detected with ELISA. The septic patients were divided into death and survival groups. The relations were compared between the changes of the levels of TNF-α, HMBG- 1, TF and vWF from septic patient peripheral blood with the illness severity. Results The levels of TNF-α, HMBG-1, TF and vWF in serums from different time point septic patient were significantly higher than health group （P 〈 0.01 ）. The peak time was 24 h for TNF-α, 48 h for HMBG-1, TF and vWF, and the 24 h was lowest. By the multivariate Logistic regression analysis, the death groups were significantly higher than survival groups （P 〈 0.05 ＆ 0.01 ）. By ROC curve analysis, the 4 inflammatory factors have obvious judgment value from 72 and 120 h curves. Conclusion Firstly, the inflammatory immune response in the septic patient was excessive activated. Then the levels of detected inflammatory factors have a trend toward increased with the extension of the course and there may be a peak point. Moreover, the levels of detected inflammatory factors have a positively correlated with the course of the disease. Lastly, by dynamic detecting the changes of the levels of TNF-α, HMBG-1, TF and vWF in serum from septic patient, it can be served as a comprehensive evaluation index of the patient condition, treatment effect and prognostic judgment.