摘要
目的探讨脓毒症患者早期血清巨噬细胞炎症蛋白-2(macrophage inflammatory protein-2,MIP-2)的浓度、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、降钙素原(procalcitonin,PCT)动态变化及与预后的关系。方法采用前瞻性研究方法,选择2011年3月至2012年9月重症监护病房(ICU)62例脓毒症患者,按照目标导向治疗(EGDT)方案进行复苏,将完成6 h EGDT复苏目标者归为Ⅰ组,未完成6 h EGDT复苏目标者归为Ⅱ组。分别记录患者复苏前(T0),复苏后6 h(T6 h)及复苏后1 d(T1 d)、2 d(T2 d)、3 d(T3 d)、4 d(T4 d)、5 d(T5 d)的APACHEⅡ评分,检测患者血中MIP-2、PCT、尿素氮(BUN)及肌酐(Cr)等指标动态变化。根据患者28 d转归分为存活组和死亡组。结果Ⅰ组APACHEⅡ评分、血MIP-2、PCT及BUN、Cr于复苏成功后呈逐渐下降趋势,于T5 d最低;Ⅱ组APACHEⅡ评分、血MIP-2、PCT及BUN、Cr于复苏失败后呈逐渐上升趋势;Ⅱ组APACHEⅡ评分于T2 d时,血MIP-2于T1 d时较Ⅰ组明显升高(均P<0.05)。Ⅰ组死亡率明显低于Ⅱ组[12.5%(5/40)vs 68.2%(15/22),P<0.05]。存活组APCHEⅡ评分、血MIP-2、PCT及血BUN、Cr随病情好转逐渐下降,于T5 d最低,而死亡组则显著上升;死亡组APACHEⅡ评分于T1 d时、血MIP-2于T6 h时即较存活组明显升高(均P<0.05)。结论 MIP-2是评估脓毒症的良好指标,动态监测其变化可了解脓毒症的发展过程,结合APACHEⅡ评分及PCT变化,对疾病的严重程度及预后有重要的评估意义。
Objective To investigate the dynamic changes of the serum levels of macrophage inflammatory protein-2（MIP2） and procalcitonin（PCT）,and acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score as well as their relationship with the prognosis of patients with sepsis.Methods In the prospective study,62 patients in intensive care unit（ICU） from March 2011 to September 2011 suffered from sepsis were enrolled and treated according to the early goal-directed therapy（EGDT）.The patients were divided into 2 groups according to the EGDT outcome（group Ⅰ： recovery within 6 hours;group Ⅱ： not recovery within 6 hours）.The levels of APACHE Ⅱ score,MIP-2,PCT,blood urea nitrogen（BUN） and creatinine（Cr） were monitored before resuscitation（T0） and at 6 hours（T6 h）,1（T1 d）,2（T2 d）,3（T3 d）,4（T4 d） and 5（T5 d） after resuscitation.According to the 28-day prognosis,all the patients were divided into a survival group and a death group.Results The levels of APACHEⅡ score,MIP-2,PCT,BUN and Cr in the group Ⅰ decreased after fluid resuscitation,and decreased to the lowest at T5 d.The levels of APACHE Ⅱ score,MIP-2,PCT,BUN and Cr in the group Ⅱ increased after failure of fluid resuscitation.The levels of APACHE Ⅱ score at T2 d,MIP-2 at T1 d and PCT at T2 d in the group Ⅱ were significantly higher than those in the group Ⅰ（both P 0.05）.The mortality in the group Ⅰ was significantly lower than that in the group Ⅱ [12.5%（5 /40） vs 68.18%（15 /22）,P 0.05].The levels of APCHE Ⅱ score,MIP-2,BUN and Cr in the survival group were decreased with the clinical condition improved,and decreased to the lowest at T5 d.The levels of APACHE Ⅱ score at T1 d and MIP-2 at T6 h in the death group were significantly higher than those in the survival group（both P 0.05）.Conclusion The serum level of MIP-2 is helpful to understand the development of sepsis by continuous surveillance,and is very important for the evaluation of severity and prognosis of
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2013年第15期1591-1595,共5页
Journal of Third Military Medical University
基金
全军医学科学技术研究"十二五"科研重点项目(BWS11J038)~~
