可溶性P-选择素及血栓调节蛋白在多器官功能障碍综合征早期诊断中的意义

目的 :观察多器官功能障碍综合征 (MODS)患者的内皮细胞功能改变 ,寻求早期诊断方法。方法 :采用免疫荧光技术连续监测 30例 ICU中严重感染、创伤患者外周血可溶性 P选择素 (s P选择素 )和血栓调节蛋白 (TM)浓度的动态变化 ,并计算其诊断 MODS的灵敏度、特异性和正确诊断指数。结果 :发生 MODS患者的 s P选择素、TM水平比未发生 MODS患者明显升高 (P均 <0 .0 5 )。 s P选择素对 MODS的诊断灵敏度高 ,但特异度不理想 ,诊断能力不高 ;提高诊断的截断值其特异度和正确诊断能力提高。TM对 MODS诊断的灵敏度高而特异度不足 ;诊断能力低 ;提升截断值后灵敏度下降 ,特异度提高 ,诊断能力提高 ,但 TM仍不足以作为独立的 MODS诊断指标。两个指标联合诊断意义更大。结论 :s P 选择素联合 TM有助于 MODS早期诊断

Significance of soluble P-selectin and thrombomodulin in early diagnosis of multiple organ dysfunction syndrome

Objective:To observe the change of endothelium function in multiple organ dysfunction syndrome(MODS),and determine the early diagnosis method.Methods:The plasma levels of soluble Pselectin(sPselectin) and thrombomodulin(TM) in 30 patients of severe infection and trauma were examined by immunofluorescence,and the sensitivity,specificity and the r (Youden's index) of the diagnosis method were calculated.Results:The levels of the sPselectin and TM in MODS were significantly higher than non MODS (all P <0 05). The diagnosis sensitivity of sPselectin was high,but the specificity wasn't ideal,the diagnosis ability was insufficiently.If increase the cutoff point,the specificity and the correct diagnosis ability would improve. The diagnosis sensitivity of TM was high,but the specificity wasn't enough,the diagnosis ability was low.If increase the cutoff point,the sensitivity will decrease and the specificity will increase,the diagnosis ability would improve,but the TM wasn't sufficiently to be the diagnosis parameter of MODS individually. The significance of combined 2 parameters was higher.Conclusions:It's possible to diagnosis the MODS at the early stage by detecting the sPselectin and TM.