血清中介素水平在脓毒症发生发展中的作用

摘要

目的 探讨血清中介素(IMD)在脓毒症发生发展中的作用.方法 选择2015年8月1日-11月30日宁夏医科大学总医院重症医学科收治的71例感染患者,按患者感染的严重程度分为全身炎症反应综合征(SIRS)组16例、脓毒症组20例、严重脓毒症组17例及脓毒性休克组18例;选择同期17例健康体检者作为对照组.所有研究对象于入院24 h内取静脉血检测血清IMD水平,并进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分、检测降钙素原(PCT)值、乳酸(Lac)水平及记录患者28 d的预后.结果 四组患者血清IMD水平均低于对照组(P＜0.001),随着脓毒症病情加重,血清IMD水平逐渐降低(P＜0.008);存活组血清IMD水平高于死亡组(P＜0.05).Spearman相关性分析结果显示:血清IMD与PCT、Lac水平、APACHEⅡ和SOFA评分均呈负相关(P均＜0.001).结论 IMD参与了脓毒症的发生发展过程,并与病情严重程度及预后密切相关.%Objective To explore the effect of serum Intermedin (IMD) on incidence of sepsis.Method A prospective study was conducted.the clinical data of 71 patients with infection were recruited who were in ICU of the General Hospital of Ningxia Medical University from August 1,2015 to November 30th,2015.The patients were divided into SIRS group (16 cases),sepsis group (20 cases),severe sepsis group (17 cases) and septic shock group (18 cases),and 17 healthy persons were selected as the control group.Venous blood samples were collected in all subjects within 24 hours after admission in ICU.The serum IMD levels were detected using enzyme-linked immuno sorbent assay (ELISA) while the Acute Physiology and Chronic Health Evaluation score Ⅱ(APACHE Ⅱ) and Sequential Organ Failur Assessment(SOFA)score were recorded.The procalcitonin (PCT)and lactate(Lac) levels of the patients were detected at the first 24 hours in ICU and the patients' prognosis for 28 days were recorded.Results The serum levels of IMD in all experiment groups were significantly lower than those of healthy control group (P＜0.001) and with the aggravation of sepsis,the level of serum IMD decreased (P＜0.008).The serum levels of IMD in survival group were significantly higher than those in non-survival group.Spearman correlation analysis method showed that there were significantly negative correlation between IMD and PCT,Lac,APACHE Ⅱ and SOFA(P＜0.001).Conclusion IMD is involved in the occurrence and development of sepsis.It is closely related to the severity and the prognosis of sepsis,and probably plays a protective role in the disease.