脓毒症患者炎症因子与内毒素变化和细菌类型及病情的关系研究

Relationship between inflammatory factors,endotoxin changes and bacterial type and condition in sepsis patients

目的探讨细菌血流感染致脓毒症患者血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、内毒素的变化与细菌感染类型及患者病情的关系。方法选取2015年2月-2018年10月河南省人民医院确诊的脓毒症患者80例作为病例组、同期健康体检志愿者80名作为对照组,对比两组研究对象的血清PCT、hs-CRP、内毒素水平,并按照病原菌类型分层分析病例组患者的血清PCT、hs-CRP、内毒素水平,采用线性相关分析法分析血清PCT、hs-CRP、内毒素与急性生理与慢性健康评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)的关系。结果病例组患者的血清PCT、hs-CRP及内毒素分别为(1.22±0.40)μg/L、(86.14±24.71)mg/L及(11.39±4.39)ng/L高于对照组(P<0.05);革兰阳性菌感染的脓毒症患者血清PCT、hs-CRP及内毒素分别为(0.75±0.32)μg/L、(65.40±22.33)mg/L及(6.77±3.95)ng/L低于革兰阴性菌感染的脓毒症患者(P<0.05);革兰阳性菌感染的脓毒症患者APACHEⅡ评分、SOFA评分分别为(9.44±3.02)分、(26.81±4.20)分低于革兰阴性菌感染的脓毒症患者;脓毒症患者APACHEⅡ评分、SOFA评分与患者的血清PCT、hs-CRP及内毒素水平均呈正相关(P<0.001)。结论革兰阴性菌感染导致的脓毒症患者血清PCT、hs-CRP、内毒素水平升高更显著,并且与患者病情严重程度的关系更加显著。

OBJECTIVE To investigate the relationship between serum PCT,hs-CRP and endotoxin and the types of bacterial infection and conditions in patients with sepsis caused by bacterial bloodstream infection.METHODS Eighty patients with sepsis diagnosed by Henan Provincial People’s Hospital from Feb.to May 2018 were selected as the case group and 80 volunteers of the same period underwent physical examination were used as the control group.The serum PCT,hs-CRP and endotoxin levels of subjects in two groups were compared,and the serum PCT,hs-CRP and endotoxin levels of subjects in case group were analyzed according to the pathogen type.The relationship between serum PCT,hs-CRP,endotoxin and APACHE II score,SOFA score was analyzed by linear correlation analysis.RESULTS The serum PCT,hs-CRP and endotoxin in the case group were(1.22±0.40)μg/L,(86.14±24.71)mg/L and(11.39±4.39)ng/L,respectively,significantly higher than those in control group(P<0.05).Serum PCT,hs-CRP and endotoxin in sepsis patients with gram-positive bacterial infection were(0.75±0.32)μg/L,(65.40±22.33)mg/L and(6.77±3.95)ng/L,respectively,significantly higher than those in sepsis patients with gram-negative bacterial infection(P<0.05).The APACHE II score and SOFA score of sepsis patients infected with Gram-positive bacteria were(9.44±3.02)and(26.81±4.20),respectively,lower than those infected with Gram-negative bacteria.The APACHE II score and SOFA score of patients with sepsis were positively correlated with serum PCT,hs-CRP and endotoxin levels(P<0.001).CONCLUSION Serum PCT,hs-CRP,and endotoxin levels in patients with sepsis caused by Gram-negative bacterial infection were more significant,and the relationship with the severity of the patient’s condition was more significant.