脓毒症患者血栓调节蛋白和纤溶酶原激活物抑制剂-1及内皮细胞损伤程度的研究初探

The correlation of plasma thrombomodulin plasminogen activator inhibitor-1 and endothelial cell injury in septic patients

研究血栓调节蛋白(TM)和纤溶酶原激活物抑制剂-1(PAI-1)与脓毒症内皮细胞损伤严重程度的相关性。选2017年2月—2019年2月华中科技大学协和江北医院重症医学科脓毒症患者100例,根据疾病严重程度分为感染性休克组50例,脓毒症组50例,另选健康体检者80例为健康对照组。检测3组受试者TM、PAI-1及循环内皮祖细胞(cEPCs)、内皮特异性分子1(ESM-1)、血管性血友病因子(vWF)水平,分析其相关性。结果显示,感染性休克组TM、PAI-1高于脓毒症组;脓毒症组TM、PAI-1高于健康对照组(P<0.05)。感染性休克组、脓毒症组cEPCs、ESM-1、vWF水平均高于健康对照组,感染性休克组高于脓毒症组,差异均有统计学意义(P<0.05)。相关性分析显示,cEPCs、ESM-1、vWF与TM、PAI-1均存在正相关关系(r分别为0.561、0.576,P值均<0.05;r分别为0.558、0.603,P值均<0.05;r分别为0.677、0.692,P值均<0.05)。TM、PAI-1与脓毒症患者内皮细胞损伤严重程度密切相关,当内皮细胞损伤越严重,TM、PAI-1及cEPCs、ESM-1、vWF水平越高,为脓毒症患者后期治疗提供有利依据。

To study the correlation of plasma thrombomodulin(TM),plasminogen activator inhibitor-1(PAI-1)and endothelial cell injury in septic patients.A total of 100 septic patients were enrolled from February 2017 to February 2019 in Intensive Care Unit(ICU),Union Jiangbei Hospital,Huazhong University of Science and Technology.Subjects were divided into two groups including 50 patients with septic shock and 50 patients with only sepsis.Then 80 healthy subjects were selected as the healthy controls.Plasma TM,PAI-1,circulating endothelial progenitor cells(cEPCs),endothelia-specific molecule-1(ESM-1),von Willebrand factor(vWF)were tested.The levels of TM and PAI-1 in septic shock group were higher than those in sepsis only group.TM and PAI-1 in all subjects were significantly higher than those in control group(P<0.05).The cEPCs,ESM-1,vWF in septic patients were higher than those in control group,furthermore,all these parameters were extra-higher in septic shock group than in sepsis only group with statistical significance(P<0.05).Correlation analysis suggested that cEPCs,ESM-1 and vWF were positively correlated with TM and PAI-1(r=0.561,0.576,P<0.05;r=0.558,0.603,P<0.05;r=0.677,0.692,P<0.05).In conclusion,plasma TM and PAI-1 are closely related to the severity of endothelial cell injury in patients with sepsis.The more serious the damage of endothelial cells is,the higher the TM,PAI-1,cEPCs,ESM-1 and vWF levels are,which could be criterion for treatment evaluation.