P-选择素水平及血小板计数在重症感染患者的临床价值

发布时间：2018-06-01 04:18

本文选题：重症感染 + P-选择素　；参考：《郑州大学》2013年硕士论文

【摘要】：背景重症感染是由于病原微生物在机体内繁殖,引起某一脏器或全身性感染,且致该器官或全身多脏器功能损害为特征的临床综合症。尽管抗感染药物、多器官支持和液体复苏等综合治疗有了长足进步,但在ICU病房,重症感染仍是导致患者死亡的重要因素,其发病率在世界范围内呈逐年士升趋势。在美国,严重感染在致死原因中居第10位,每小时约有25人因重症感染死亡。我国一项多中心研究证明重症感染发生率与国外相似,约为8.68%。由于重症感染患者缺乏特异性的临床症状及体征,探索判断重症感染患者病情变化及评估预后的辅助检查显得尤为重要。研究证明,重症感染患者多伴有血小板计数的变化,缺氧、病原微生物及其毒物作为始动因子,可引起机体的微血管内皮损伤,炎症介质的释放引起血小板形态的改变、血小板聚集及血小板成分的释放,即血小板活化,这一活化过程导致血液粘滞度异常及微血栓的形成,使病情发作展迅速,最终导致多脏器功能障碍甚至多脏器功能衰竭。血小板及其活化产物广泛参与了炎症反应并在炎症进展中发挥重要作用,并在分子水平与凝血反应链之间存在错综复杂的联系。基于P-选择素作为血小板活化的“金标准”,本研究通过监测重症感染患者血浆P-选择素、血小板计数,来帮助判断重症感染患者病情变化及评估其预后。目的探讨血浆P-选择素、血小板计数能否作为判断重症感染患者病情变化及评估其预后的指标,为重症感染患者病情变化和感染控制提供重要的理论依据和方法。方法收集2011年9月至2013年2月郑州大学第一附属医院呼吸ICU病房重症感染患者80例作为感染组,其中男43例,女37例,年龄26至86岁,平均年龄56.0±3.8岁。选择同期健康体检者40例,作为对照组,其中男性20例,女性20例,年龄在20至86岁,平均年龄57.0±2.8岁,两组性别、年龄差别均无统计学意义(P0.05)。感染组在入住我科24小时内及第7天(对照组在体检当日)空腹状态下抽外周静脉血,分别采用双抗体夹心酶联免疫测定法(ELISA法)和全自动五分类血液细胞分析检测血浆P-选择素水平、血小板计数,比较两组间的血浆P-选择素水平、血小板计数有无差异,并分析感染组血浆P-选择素水平与血小板计数有无相关性；感染组根据入住我科2周内观察患者病情,根据不同转归,分为好转组和恶化组,比较两组患者在入住我科第7天的血浆P-选择素水平、血小板计数有无差异。结果 1.感染组与对照组比较,血浆P-选择素水平(μg/L)明显升高(27.60+3.24比9.41±4.63,P=0.03),差异有统学意义血小板计数(x109/L)无明显下降(198±61比236±73,P=0.58),差异无统学意义。 2.好转组与恶化组比较,入科第7天血浆P-选择素明显升高(32.24±2.87比19.62±3.48,P=0.005)、血小板计数明显下降(48±37比201±73,P=0.01),差异有统计学意义。 3.感染组入科24小时内和第7天血浆P-选择素水平与血小板计数均呈负相关(24小时内：r=-0.68,P=0.02；入科第7天：r=-0.88,P=0.001)。结论 1.重症感染患者存在血小板活化,其释放的粘附分子之一P-选择素可以作为判断重症感染患者病情变化的指标。 2.血浆P-选择素水平与血小板计数呈负相关,血浆P-选择素水平升高且血小板计数进行性下降预示着重症感染患者病情严重,预后差。
[Abstract]:background
Severe infection is a clinical syndrome caused by the pathogenic microorganism breeding in the body, causing a certain organ or systemic infection and causing the function damage of the organ or multiple organs. Despite the anti infective drugs, multiple organ support and fluid resuscitation, the comprehensive treatment has made great progress, but in the ICU ward, the severe infection is still the cause of the patient. An important factor in death, its incidence is rising year by year in the world. In the United States, serious infection is the tenth leading cause of death, and about 25 people die per hour because of severe infection. A multicenter study in China has proved that the incidence of severe infection is similar to that of foreign countries, which is about 8.68%. due to the lack of specificity in patients with severe infection. It is very important to explore the symptoms and signs. It is very important to explore the changes of the patient's condition and evaluate the prognosis of the patients with severe infection. It has been proved that the patients with severe infection are often accompanied by changes in platelet count, hypoxia, pathogenic microbes and their toxicants as a starting factor, which can cause the microvascular endothelial injury of the body and the release of the inflammatory mediators to cause the small blood. Changes in the form of platelets, platelet aggregation and release of platelet components, that is, platelet activation. This activation process leads to abnormal blood viscosity and the formation of micro thrombus, which causes rapid development of the disease and eventually leads to multiple organ dysfunction or even multiple organ failure. There is an important role in the progression of the disease, and there is a complex link between the molecular level and the coagulation reaction chain. Based on P- selectin as the "gold standard" for platelet activation, this study helps to determine the condition of severe infection patients and evaluate their prognosis by monitoring the plasma P- selectin and platelet counts in critically infected patients.
objective
To investigate whether the plasma P- selectin and the platelet count can be used as an indicator to judge the change of the patient's condition and evaluate the prognosis of the severe infection, and provide an important theoretical basis and method for the change of the patient's condition and the control of the infection.
Method
From September 2011 to February 2013, 80 cases of severe infection in the respiratory ICU ward of the First Affiliated Hospital of Zhengzhou University were collected as infection group, including 43 males and 37 females, aged from 26 to 86 years old, with an average age of 56 + 3.8 years. We selected 40 cases of healthy physical examination in the same period as the control group, including 20 men, 20 women, 20 to 86 years, average age 57 + 2. .8 years old, two groups of sex, age difference was not statistically significant (P0.05). Infection group in 24 hours in our department and the 7 day (the control group on the day of physical examination) out of the abdominal peripheral venous blood, the use of double antibody sandwich enzyme-linked immunoassay (ELISA) and the full automatic five classification of blood cell analysis of plasma P- selectin level, blood is small The level of plasma P- selectin was compared between the two groups. There was no difference in the platelet count, and there was no correlation between the plasma P- selectin level and the platelet count in the infection group. The infection group was divided into the improvement group and the worsening group according to the different outcome, and the two groups were compared to the 7 day of my section. There was no difference in plasma P- selectin level and platelet count.
Result
Compared with the control group, the level of plasma P- selectin (27.60+3.24) was significantly higher (27.60+3.24 than 9.41 + 4.63, P=0.03). There was no significant difference in platelet count (x109/L) (198 + 61, 236 + 73, P=0.58), and the difference was not significant.
2. compared with the deteriorating group, the plasma P- selectin was significantly increased (32.24 + 2.87 to 19.62 + 3.48, P=0.005), and the platelet count decreased significantly (48 + 37 compared to 201 + 73, P=0.01), and the difference was statistically significant.
The plasma P- selectin level was negatively correlated with the platelet count within 24 hours and seventh days in the 3. infection group (24 hours: r=-0.68, P=0.02, and the 7 day of entry: r=-0.88, P=0.001).
conclusion
1. platelet activation exists in critically ill patients. P- selectin, one of the adhesion molecules released, can be used as an indicator of the severity of severe infection.
2. the level of plasma P- selectin is negatively correlated with the platelet count, the level of plasma P- selectin and the progressive decrease of platelet count indicate that the patients with severe infection are seriously ill and the prognosis is poor.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

【参考文献】