ICU脓毒血症患者细菌内毒素水平与多种炎症因子的比较

Comparative evaluation of bacterial endotoxin levels and various inflammatory factors of ICU patients

目的探究ICU脓毒血症患者血液内毒素(EA)水平与多种炎症因子表达水平的关系及比较研究。方法 83例确诊为脓毒血症的ICU住院患者,搜集其临床基本资料,并对血液EA、降钙素原(PCT)、可溶性CD14亚型(Presepsin)、白细胞介素-6(IL-6)水平进行检测及比较分析。结果 EA浓度为0.4~0.6 ng/L的患者数量最多,随着EA浓度的升高,患者急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分及序贯性脏器衰竭评价评分(SOFA)显著增加,差异有统计学意义(P<0.05);血清PCT、Presepsin、乳酸、IL-6与EA浓度相关性分别为(r=0.39,P=0.041;r=0.48,P=0.018;r=0.48,P=0.029;r=0.42,P=0.038);83例入院患者血液培养阳性、阴性数量分别为31例、42例。血液培养(BC)阳性与BC阴性患者EA、PCT浓度显著升高,差异有统计学意义(P<0.05),Presepsin、IL-6浓度差异无统计学意义(P>0.05);入院28 d后,83例患者共有62例存活,21例死亡,死亡率为25.3%。与存活患者比较,死亡患者EA、Presepsin水平升高最为显著,差异有统计学意义(P<0.001)。结论 ICU住院患者EA水平与血清PCT、Presepsin、乳酸、IL-6水平存在正相关,EA水平在脓毒血症的诊断、病情严重程度的评估及对预后的预测方面具有重要的临床意义。

Objective To explore the relationship and comparative study of the expression levels of various inflammatory factors in blood endotoxin(EA) levels of ICU sepsis patients.Methods 83 ICU patients diagnosed with sepsis were enrolled in the study.The basic clinical data were collected and the levels of blood EA,procalcitonin(PCT),Presepsin and interleukin-6(IL-6) were detected and compared.Results The number of patients with EA concentration of 0.4-0.6 ng/L was the largest.With the increase of EA concentration,the patients’ acute physiology and chronic health evaluation Ⅱ(APACHE II) score and sequential organ failure evaluation(SOFA) score increased significantly(P<0.05).The correlation coefficient of serum PCT,Presepsin,lactic acid,IL-6 and EA concentration were r=0.39(P=0.041),r=0.48(P=0.018),r=0.48(P=0.029) and r=0.42(P=0.038),respectively.The number of positive and negative blood cultures in83 patients were 31 and 42,respectively.The EA and PCT concentrations of blood culture(BC) positive and BC negative patients were significantly increased,the difference was statistically significant(P<0.05).The difference of Presepsin and IL-6 concentration was not statistically significant(P>0.05).After 28 days of admission,62 patients survived and 21 died,with a mortality rate of 25.3%.Compared with the surviving patients,the EA and Presepsin levels of the dead patients were significantly increased(P<0.001).Conclusion EA levels in ICU hospitalized patients were positively correlated with serum PCT,Presepsin,lactic acid,and IL-6 levels.EA levels had important clinical significance in the diagnosis of sepsis,the assessment of the severity of the disease,and the prediction of prognosis.