缺氧诱导因子-1α与血乳酸及乳酸清除率检测在脓毒性休克患者中的意义

摘要

目的:探究缺氧诱导因子-lα及血乳酸、乳酸清除率在脓毒性休克患者中的意义.方法:采用前瞻性观察研究.选取30例健康志愿者(对照组),选取EICU的40例脓毒性休克患者,根据存活时间是否超过28 d,将入选40例脓毒性休克患者分为存活组21例(存活＞28d)与死亡组19例(存活≤28 d).应用ELISA方法检测入组时血浆中HIF-1α水平,并检测入组时(0 h),入组后6h、12h和24 h动脉血乳酸水平,统计分析血HIF-1α水平、血乳酸水平、乳酸清除率、APACHEⅡ评分和预后的关系.结果:40例脓毒性休克患者,其中男20例,女20例,平均年龄(61.3±12.8)岁;28 d病死率为47.5％;APACHE Ⅱ评分(23.7±4.83),动脉血乳酸水平(5.88±2.73) mmol/L.死亡组及存活组血浆中HIF-lα水平及血乳酸较对照组均显著升高(P均＜ 0.05),且死亡组升高更为显著(P＜0.05);死亡组6h、12h及24 h乳酸清除率均低于生存组(P＜0.01),APACHEⅡ评分高于存活组(P＜0.05),差异有统计学意义.血乳酸及HIF-lα水平呈正相关(r=0.868,P＜ 0.01).血乳酸及HIF-lα水平与患者APACHEⅡ评分呈正相关,(r=0.804,P＜0.01)和(r=0.811,P＜0.01).结论HIF-lα及血乳酸,乳酸清除率与脓毒性休克病情的严重程度及预后密切相关,可能成为其预后评估的重要指标.%Objective To investigate the significance of hypoxia inducible factor lα and lactate and lactate clearance in patients with septic shock.Methods A prospective observational study was conducted.Thirty healthy volunteers (control group) and 40 cases of septic shock patients in EICU were recruited.According to the survival time,40 patients with septic shock were divided into survival group (21 cases,survival time ＞ 28 days) and death group (19 cases,survival time ≤ 28 d).The HIF-lα level was tested by ELISA assay.Lactate level of 0,6,12,24 h in arterial blood were also tested.Lactate clearance rate of the 6 h,12 h and 24 h were calculated.The association of HIF-1α and lactate level and lactate clearance rate,APACHE Ⅱ score and prognosis were evaluated.Results 40 patients with septic shock,20 male and 20 femnales,the mean age was (61.3 ± 12.8) years.The 28 day mortality rate was 47.5％.The average APACHE Ⅱ score was (23.7 ± 4.83) and arterial blood lactate levels was (5.88 ± 2.73) mmol/L.In death group and survival group,the levels of HIF-1α levels and blood lactate were significantly higher than that in the control group (P ＜ 0.05).The death group increased more significantly (P ＜ 0.05).In death group,the 6 h,12 h and 24 h lactate clearance rate were lower than the survival group (all P ＜ 0.01).APACHE Ⅱ score were higher than that in survival group (P ＜ 0.05) and the difference is statistically significant.The lactate and HIF-1α were positively correlated (r =0.868,P ＜ 0.01).Blood lactate and HIF-1α levels were all positively correlated with APACHEⅡ score (r =0.804,P ＜ 0.01) and (r =0.811,P ＜ 0.01).Conclusion The level of HIF-1α,blood lactate,lactate clearance rate are closely related with the severity and prognosis of septic shock and may become an important indicator of the prognosis.