重症脓毒症细菌感染患者炎症因子与FIB和AT-Ⅲ的变化研究

Changes of inflammatroy factors and FIB and AT-Ⅲlevels in patients with severe sepsis bacterial infection

目的观察重症脓毒症细菌感染患者降钙素原(Procalcitonin,PCT)、超敏C-反应蛋白(Hypersensitivity protein C,hs-CRP)、纤维蛋白原(Fibrinogen,FIB)、抗凝血酶Ⅲ(Antithrombin III,AT-Ⅲ)水平,并分析其临床意义。方法选取2017年2月-2018年2月在内蒙古包钢医院接受治疗的重症脓毒症细菌感染患者100例为研究对象,根据其疾病严重程度分为严重脓毒症组58例和脓毒症休克组42例,观察患者预后情况。观察严重脓毒症组和脓毒症休克组、存活和死亡患者血清PCT、CRP等炎症因子、FIB、AT-Ⅲ等凝血指标和免疫球蛋白G(Immunoglobulin G,IgG)、免疫球蛋白A(ImmunoglobulinA,IgA)、免疫球蛋白M(ImmunoglobulinM,IgM)等免疫功能,分析重度脓毒症细菌感染患者炎症因子与FIB、AT-Ⅲ等凝血指标和免疫功能的相关性。结果脓毒症休克组患者的PCT、CRP和IL-6水平分别为(6.85±0.89)ng/ml、(448.98±15.06)mg/dl、(49.95±4.32)pg/ml高于严重脓毒症组(P<0.001);脓毒症休克组患者IgG、IgA、IgM、FIB和AT-Ⅲ分别为(9.05±1.76)g/L、(2.30±1.11)g/L、(1.41±0.97)g/L、(2.23±0.48)g/L、(152.35±5.41)mg/L,低于严重脓毒症组(P<0.001);死亡患者的血清PCT、CRP、IL-6分别为(8.11±1.25)ng/ml、(485.76±10.98)mg/dl、(55.12±4.28)pg/ml,高于存活患者(P<0.05);死亡患者的IgG、IgA、IgM、FIB和AT-Ⅲ水平分别为(8.02±1.69)g/L、(2.15±0.78)g/L、(1.25±0.92)g/L、(2.14±0.65)g/L、(138.94±4.82)mg/L,低于存活组(P<0.001);重度脓毒症细菌感染患者的PCT、CRP和IL-6水平与IgG、IgA、IgM、FIB和AT-Ⅲ水平负相关(P<0.05)。结论重症脓毒症细菌感染患者PCT、CRP水平较高,FIB、AT-Ⅲ水平较低,且与患者的疾病程度和预后相关。

OBJECTIVE To observe the procalcitonin(PCT),hypersensitivity protein C(CRP),fibrinogen(FIB),and antithrombinⅢ(AT-III)in patients with severe sepsis bacterial infection,and analyze their clinical significance.METHODS A total of 100 patients with severe sepsis bacterial infection treated in Baogang Hospital of Inner Mongolia from Feb.2017 to Feb.2018 were selected as the research subjects,and were divided into 58 cases of severe sepsis group and 42 cases of septic shock group according to the severity of the disease.The prognosis of all the patients were observed.Serum inflammatory factors such as PCT and CRP,coagulation indicators such as FIB and AT-Ⅲ,and immune functions indicators including immunoglobulin G(IgG),immunoglobulin A(IgA)and immunoglobulin M(IgM)in survived and death patients with severe sepsis and septic shock were observed,and the correlation between inflammatory factors and coagulation indicators such as FIB,AT-Ⅲand immune function in patients with severe sepsis bacterial infection were analyzed.RESULTS The levels of PCT,CRP and IL-6 of patients in septic shock group were(6.85±0.89)ng/ml,(448.98±15.06)mg/dl,and(49.95±4.32)pg/ml,respectively,significantly higher than those of patients in severe sepsis group(P<0.001).The IgG,IgA,IgM,FIB and AT-Ⅲof patients in septic shock group were(9.05±1.76)g/L,(2.30±1.11)g/L,(1.41±0.97)g/L,(2.23±0.48)g/L,and(152.35±5.41)mg/L,respectively,significantly lower than those of patients in the severe sepsis group(P<0.001).The serum PCT,CRP,and IL-6 of the death patients were(8.11±1.25)ng/ml,(485.76±10.98)mg/dl,and(55.12±4.28)pg/ml,respectively,significantly higher than those of the survival patients(P<0.001).The levels of IgG,IgA,IgM,FIB and AT-Ⅲof the dead patients were(8.02±1.69)g/L,(2.15±0.78)g/L,(1.25±0.92)g/L,(2.14±0.65)g/L,and(138.94±4.82)mg/L,respectively,significantly lower than those of the survival patients(P<0.001).The PCT,CRP and IL-6 levels of patients in severe sepsis infection group were negatively correlated with IgG,IgA,IgM,FIB and AT-Ⅲlevels(P<0.05).CONCLUSIONS The PCT and CRP levels were higher in patients with severe septic bacterial infection,while FIB and AT-Ⅲlevels were lower,which were related to disease severity and prognosis of the patients.