外周血内毒素与内外科重症患者死亡率的关系

The Correlation between Endotoxin Level of Peripheral Venous Blood and the Mortality of the Critically Illed Patients

目的对内毒素检测方法及内外科重症患者外周血内毒素水平与患者死亡率的预测进行研究。方法用稀释加热处理后的健康人血浆代替无热原水,稀释健康人和患者的血浆标本。用APACHEⅡ评分系统,大于7分者为观察对象,48例急诊内外科重症患者进入本研究。患者均于就诊6h内取血作生化检验,用Vacutainer无热原试管加取1.5ml全血,进行血浆分离,保存于-30℃冰箱2周内检测。临床观察2周,记录有无死亡。数据用标准统计软件StatviewSE作统计分析,P<0.05时有显著意义。结果内毒素升高的患者(10pg/ml左右时),其测量误差可达20%。50例健康人内毒素浓度为(3.9±0.7)pg/ml。48例重症患者APACHEⅡ评分范围为7～30分,外周血内毒素浓度为(11.4±2.7)pg/ml,明显高于正常人(P=0.0001)。当周围血内毒素值分为三组(6.0～9.9pg/ml,10.0～14.9pg/ml,15.0～20.0pg/ml)时,观察到死亡率分别为0、30.0%、75.0%,两者有明显相关性(r=0.99,P=0.04)。当APACHEII评分也分为三组(7～14分,15～19分,20～30分)时,患者死亡率分别为0、54.5%、66.7%,两者亦相关(r=0.88,P=0.31)。结论重症患者早期外周血内毒素的水平与疾病死亡率明显相关,观察早期外周血内毒素的水平对预测患者的预后有一定临床意义。

Objective The method for measuring the endotoxin in peripheral venous blood was studied and the correlation between endotoxin level and the mortality of the critically illed patients was evaluated.Methods Peripheral venous blood samples were taken from50healthy people and48critically illed patients.Limulus Lysate Test with chromogenic substrate was used in endotoxin analysis.The patients with APACHEⅡscore>7were enrolled into the study.The standard endotoxin was diluted with prepared human plasma to create the standard curve.The mortality of the patients within2weeks was recorded Results1.When the standard endotoxin was diluted with plasma,the standard curve and the endotoxin level were different from those diluted with pyrogen-free water and the difference was over20%in patients with moderate increase of endotoxin level.2.The endotoxin level of the50healthy persons was (3.9±0.7)pg/ml.3.The endotoxin concentration in the48critically illed patients was much higher than that of healthy volunteers(P=0.0001).4.The patients were divided into3groups according to their endotoxin levels(6.0～9.9pg/ml,10.0～14.9pg/ml and15.0～20.0pg/ml )and the mortalities were0%,30.0%and75%respectively.Thus,a positive correlation was found between the endotoxin level and the mortality (r=0.99,P=0.04).If the patients were divided into3groups according to APACHEⅡscores,the mortalities were0%,54.5%and66.7%respectively,there was no positive correlation between the endotoxin level and the mortality (r=0.88,P=0.31).Conclusions The study suggested that the endotoxin level in peripheral venous blood of the critically illed patients was correlated with the mortality.The endotoxin level could be used in predicting the outcomes of the critically illed patients.