Objective To Explore ihe dynamic changes and clinical significance of ihe p - seleclin (CD62p) in largel glucose conlrol iherapy for serious seplic palienls. Methods 45 serious seplic palienls were randomly divided inlo Lwo groups; LargeL glucose conlrol A group 23 cases ( glucose conlrol in 4. 1 ~6. 1 mmol/L) and largel glucose conlrol B group 22 cases (blood glucose conlrol in 6.2 ~8. 3 mmol/L). In admilled cases were given largel glucose conlrol, Enzyme linked immunosorbenl assay( ELISA) was used in ihe deleclion of CD62p in 0 h, 8 h, 12 h, 24 h, and 72 h in all palienls wilh serious seplic palienls. Wilh biochemical inslrumenl delerminalion levels of plalelel( PLT) , and prolhrombin lime ( PT ) , aclivaled parlial ihromboplaslin lime ( APTT ) and fibrinogen ( FIB ) , and observing Score of acule physiology and chronic heallh evaluation II ( APACHE II ) and record 28 d mortality. Also survival under 28 d divides palienls inlo dealh unil (11 cases) and survival sel (33 cases) comparative analysis. Results Bolh APACHE II and CD62p levels in A and B group decreased wilh passage of lime, ihe differences were significant belween the resulls in 24 h, 72 h comparison of trealmenl on admission ( bolh P < 0. 05 ) . In the A group, APACHE II and CD62p levels decreased, and ihey were lower than ihose in B group 72 h after Ireatmenl ( both P < 0. 05 ) . The mortality rale in 28days also lowered[21. 74% vs. 27. 27% ] in A group, bul ihe difference was nol significant (P > 0.05). Dealh group CD62p and APACHE II scores significantly are higher lhan survival group, ihe difference wilh slalislically significance (P < 0. 05). Admission in palienls wilh sepsis CD62p, APACHE II scores is positive (r =0.734, P <0. 01). Conclusion target glucose control management can significantly suppress the expression of CD62p, lower fatality rate, P - selectin is expected to become a good indicator to determine the sepsis severity and prognosis.%目的 探讨严重脓毒症目标血糖管理过程中P-选择素(CD62p)浓度的动态变化及其临床意义.方法 将45例严重脓毒症患者随机分为:A组23例(目标血糖控制在4.1～6.1 mmol/L);B组22例(目标血糖控制在6.2～8.3 mmol/L).在入院时就给予目标血糖控制,分别在第0、8、12、24及72小时采集静脉血,用ELISA法检测CD62p浓度,用生化仪测定血小板计数(PLT)、血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)及纤维蛋白原(FIB)的变化;相同时间点观察急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分,并计算28 d病死率.另外,根据28 d生存情况将患者分为死亡组和存活组进行对比分析.结果 A、B两组随着治疗时间的延长,CD62p浓度及APACHEⅡ评分均下降,治疗第24、72小时与入院时比较差异有统计学意义(P均<0.05);治疗第72小时A组CD62p浓度及APACHEⅡ评分均低于B组(P均<0.05).28 d病死率:A组21.74%(5/23)与B组27.27%(6/22)比较降低,但差异无统计学意义(P>0.05).两组治疗前后PT、APTT、FIB和PLT差异均无统计学意义(P>0.05).死亡组CD62p浓度及APACHEⅡ评分均明显高于存活组,差异有统计学意义(P<0.05).脓毒症患者入院时 CD62p浓度与APACHEⅡ评分呈正相关(r=0.734,P<0.01).结论 严重脓毒症患者在目标血糖管理下,能显著抑制CD62p浓度、降低病死率和改善预后,CD62p有望成为判断脓毒症病情严重程度和预后的良好指标.
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