脓毒症患者内源性硫化氢水平变化及其与凝血功能的关系

Change in endogeous hydrogen sulfide in patients with sepsis and its relationship with coagulation function

目的探讨脓毒症(sepsis)患者内源性硫化氢(H2S)水平的变化及其与凝血功能的关系。方法选取2017年7月至2018年6月重庆市巴南区人民医院收治的35例脓毒症患者(脓毒症组)和35例脓毒性休克(脓毒性休克组)患者作为研究对象,选择同期健康体检者35例作为对照组。留取三组受检者空腹静脉血,测定血浆H2S、凝血因子Ⅷ(FⅧ)、纤溶酶原(PLG)、抗凝血酶(AT)、组织因子(TF)、血小板计数(PLT)、肿瘤坏死因子-α(TNF-α)含量,并对H2S与凝血功能各指标行相关性分析。结果与对照组比较,脓毒症组、脓毒性休克组患者血浆H2S、FⅧ、TF及TNF-α表达均显著升高,血浆PLG、AT活性显著降低,血小板计数显著下降,且脓毒性休克组各指标升高或降低较脓毒症组更明显,差异均具有统计学意义(P<0.05)。H2S与TF、FⅧ、TNF-α正相关(r=0.70、0.54、0.64,P<0.05),与PLG、AT负相关(r=-0.71、-0.55,P<0.05)。结论脓毒症患者内源性H2S可能通过上调TF、TNF-α来介导凝血功能障碍。

Objective To study the change in endogenous hydrogen sulfide(H2S)in patients with sepsis and its relationship with coagulation function.Methods Thirty-five patients with sepsis(sepsis group)and thirty-five patients with septic shock(septic shock group)admitted to People’s Hospital of Ba’nan District of Chongqing from July 2017 to June 2018 were enrolled.Thirty-five healthy persons served as control(control group).Blood was collected to determine the levels of H2S,blood coagulation factorⅧ(FⅧ),plasminogen(PLG),antithrombin(AT),platelet count(PLT),tissue factor(TF),tumor necrosis factor-α(TNF-α).The correlations among the above parameters were analyzed.Results Compared with control group,the levels of H2S,FⅧ,TF,and TNF-αin sepsis group and septic shock groups were significantly elevated(all P<0.05),the PLG,AT activity,and platelet count were significantly decreased(all P<0.05).The changes in the parameters in septic shock group were more remarkable than those in sepsis group(all P<0.05).H2S was positively correlated with TF,FⅧ,and TNF-α(r value was 0.70,0.54,0.64,all P<0.05),and it was negatively correlated with PLG and AT(r value was-0.71,-0.55,both P<0.05).Conclusion As an inflammatory factor,endogenous H2S deteriorates coagulation function in patients with sepsis by up-regulating TF and TNF-α.