急诊脓毒血症患者血清氧化应激指标水平与疾病预后相关性分析

Correlation analysis of serum oxidative stress index levels and prognosis of patients with emergency sepsis

目的:探究急性脓毒血症患者血清氧化应激指标水平与预后的相关性。方法:选择收治的脓毒血症患者75例,依据患者病情将其分为脓毒症组(轻度脓毒血症)、重度组(重度脓毒血症)和休克组(脓毒性休克),比较三组入院时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、肝功能指标[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]、肾功能指标[血肌酐(SCr)、尿素氮(BUN)]、甲状腺功能指标[促甲状腺激素(TSH)、三碘甲状腺原氨酸(T 3)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)]和28 d病死率。对比28 d存活者和死亡者性别、年龄、APACHEⅡ评分、AST、ALT、SCr、BUN、TSH、T 3、SOD、MDA、GSH-PX,Pearson相关系数法分析血清SOD、MDA、GSH-PX水平与APACHEⅡ评分、AST、ALT、SCr、BUN、TSH、T 3、28 d病死率的相关性。结果:重度组和休克组APCHEⅡ评分和血清AST、ALT、SCr、BUN、MDA水平均显著高于脓毒症组,休克组显著高于重度组(P<0.05);重度组和休克组血清TSH、T 3、SOD、GSH-PX水平均显著低于脓毒症组,休克组显著低于重度组(P<0.05)。脓毒血症死亡者APCHEⅡ评分和血清AST、ALT、SCr、BUN、MDA水平均显著高于存活者,血清TSH、T 3、SOD、GSH-PX水平均显著低于存活者(P<0.01)。患者血清氧化应激指标SOD和GSH-PX水平与血清AST、ALT、SCr、BUN水平和APCHEⅡ评分、28 d病死率显著负相关,与血清TSH和T 3水平显著正相关(P<0.05)。氧化应激指标MDA水平与血清AST、ALT、SCr、BUN水平和APCHEⅡ评分、28 d病死率显著正相关,与血清TSH和T 3水平显著负相关(P<0.05)。结论:脓毒血症患者血清氧化应激指标水平与其病情严重程度、器官功能损伤和预后不良显著相关,可作为患者病情和预后判断的潜在指标。

Objective:To explore the correlation between serum oxidative stress index levels and prognosis of patients with acute sepsis.Methods:Seventy-five patients with sepsis were divided into sepsis group(mild sepsis),severe group(severe septicopyemia)and shock group(septic shock)according to their condition.Acute physiology and chronic health evaluationⅡ(APACHEⅡ),liver function indexes[aspartate aminotransferase(AST),alanine aminotransferase(ALT)],renal function indexes[serum creatinine(SCr),blood urea nitrogen(BUN)],thyroid function indicators[thyroid stimulating hormone(TSH),triiodothyronine(T 3)],oxidative stress indicators[superoxide dismutase(SOD),malondialdehyde(MDA),glutathion peroxidase(GSH-PX)]and 28-day mortality were compared among the three groups.The gender,age,APACHEⅡscore,AST,ALT,SCr,BUN,TSH,T 3,SOD,MDA,and GSH-PX were compared between 28-day survivor and the dead patients.Pearson correlation coefficient method was used to analyze the correlation between serum SOD,MDA,GSH-PX levels and APACHEⅡscore,AST,ALT,SCr,BUN,TSH,T 3,28-day mortality.Results:The APCHEⅡscores and serum AST,ALT,SCr,BUN and MDA levels of the severe group and shock group were significantly higher than those of the sepsis group,and those of the shock group were significantly higher than those of the severe group(P<0.05).The levels of serum TSH,T 3,SOD and GSH-PX of the severe group and shock group were significantly lower than those of the sepsis group,and those of the shock group were significantly lower than those of the severe group(P<0.05).The APCHEⅡscore and serum AST,ALT,SCr,BUN,and MDA levels of sepsis-dead patients were significantly higher than those of survivors,and serum TSH,T 3,SOD and GSH-PX levels were significantly lower than those of survivors(P<0.01).The SOD and GSH-PX levels were significantly negatively correlated with serum AST,ALT,SCr,BUN levels,APCHEⅡscore and 28-day mortality rate,and significantly positively correlated with serum TSH and T 3 levels(P<0.05).The level of MDA was significantly positively correlated with serum AST,ALT,SCr,BUN levels,APCHEⅡscore,28-day case fatality rate,and significantly negatively correlated with serum TSH and T 3 levels(P<0.05).Conclusion:The level of serum oxidative stress indicators in patients with sepsis is significantly related to the severity of the disease,organ function damage and poor prognosis,and can be used as a potential indicator for the judgment of the patient’s condition and prognosis.