摘要
目的 研究低分子肝素治疗脓毒症过程中P-选择素（CD62p）表达的动态变化及其临床意义.方法 20例健康体检者为正常组.将40例脓毒症患者随机分为对照组和抗凝组,在诊断脓毒症第1、3、5、7天,采用ELISA法检测CD62p表达,同时观察急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）及血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、血小板（PLT）和D-二聚体（D-D）的变化,并统计多器官功能障碍综合征（MODS）发生率及28 d病死率.结果 与正常组比较,对照组CD62p表达显著增加（P均〈0.05）.随着时间的延长,抗凝组CD62p表达及APACHEⅡ评分均下降,治疗第5、7天与治疗第1天比较差异有统计学意义（P均〈0.05） 而对照组两指标是先下降后升高.治疗第7天抗凝组CD62p表达及APACHEⅡ评分均低于对照组（P均〈0.05）.抗凝组MODS发生率（20%）较对照组降低（50%,P〈0.05） 28 d病死率（20%）也较对照组（35%）降低,但差异无统计学意义（P〉0.05）.对照组和抗凝组治疗前后PT、APTT、FIB、PLT和D-D水平比较差异均无统计学意义（P均〉0.05）.抗凝组CD62p表达与APACHEⅡ评分呈正相关（r=0.989,P=0.011）.结论 脓毒症早期血小板就处于高激活状态,且活化程度与疾病严重程度呈正相关 早期应用低分子肝素治疗脓毒症,可显著抑制CD62p表达,降低MODS发生率,改善预后,且临床应用安全.
Objective To explore the dynamic changes and clinical significance of the P - selectin （CD62p） in low molecular weight heparin （LMWH）therapy for septic patients. Methods Twenty healthy people for physical examination were selected as normal contrast group. Forty sepsis patients were randomly divided into two groups： routine treatment group and LMWH treatment group. Enzyme- linked immunosorbent assay （ELISA） was used in the detection of CD62p on 1 （the day of sepsis diagnosis）, 3, 5, 7 day in all patients with sepsis. Score of Acute Physiology and Chronic Health Evaluation II （APACHE Ⅱ ）, prothrombin time （PT）, activated partial thromboplastin time （AFFr）, fibrinogen （FIB）, levels of platelet （PLT） and D - dimer（ D- D）were observed. To count incidence rate of multiple organ dysfunction score （MODS） incidence rate and mortality rate in 28 days. Results The expression levels of CD62p were much more in contrast group compared with normal contrast group, and the difference was statistically significant （ P 〈 0.05 ）. Both APACHE II and CD62p levels in anticoagnlation group decreased with the passage of time, the differences were significant between the results of 5, 7 day and that of the first day （ both P 〈 O. 05）. In the contrast group, APACHE 1/and CD62p levels decreased first and then increased, and they were higher than those in anticoagnlation group on 7 day after treatment （ both P 〈 0.05 ）. Compared with contrast group, MODS incidence rate lowered in anticoagulation group（ 20% vs 50% ）, and the difference was statistically significant （P 〈 0. 05）; The mortality rate in 28 days also lowered in anticoagulation group（20% vs 35% ）, but the difference was not significant （P 〉 0.05 ）. The difference of PT, APTT, FIB, PLT and D - D was not significant between the two treatment groups （ P 〉 0.05 ）. The correlation of CD62p with APACHE 11 score was analyzed in anticoagulation group, the positive correlations were found （r = 0.
出处
《中国急救医学》
CAS
CSCD
北大核心
2010年第11期976-979,共4页
Chinese Journal of Critical Care Medicine
关键词
低分子肝素
脓毒症
P-选择素
Low molecular weight heparin
Sepsis
P - selectin
