可溶性尿激酶型纤溶酶原激活物受体在预测结肠破裂术后脓毒症及评估预后的作用

目的动态监测创伤性结肠破裂患者血清可溶性尿激酶型纤溶酶原激活物受体(soluble urokinase plasminogen activator receptor,su PAR)水平,探讨此类患者术前血清su PAR水平与术后继发腹腔感染之间的关系;以及术后血清su PAR水平对其术后脓毒症严重程度的评估价值。方法安徽医科大学第二附属医院急诊外科2016年3月—2017年9月收治的创伤性结肠破裂患者55例,男性37例,女性18例,依据患者术后是否发生脓毒症,分非脓毒症组及脓毒症组;脓毒症组依据其严重程度分为脓毒症组和脓毒症休克组2组,分别于入院时及术后第24、48、72h检测血清su PAR、白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平并行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,分析比较各指标之间的差异及对术后脓毒症的预测价值。结果脓毒症组患者入院时及术后血清su PAR均明显高于非脓毒症组,差异具有统计学意义(4.63±3.19)ng/m L vs.(10.38±4.32)ng/m L,P0.05;(5.21±3.98)ng/m L vs.(12.47±4.87)ng/m L,P0.05];四个指标预测术后脓毒症的ROC曲线显示,入院时及术后24h两个时间点su PAR的预测价值均明显高于IL-6、CRP,略优于APACHEⅡ评分(AUC:0.873 and 0.809 vs.0.731 and 0.624,P0.05;AUC:0.867 and 0.814 vs.0.729 and 0.593,P0.05);脓毒症休克患者血清su PAR明显高于脓毒症患者(14.48±3.99)ng/m L vs.(8.47±3.14)ng/m L,P0.05]。结论 (1)创伤性结肠破裂患者入院时血清su PAR水平对预测术后脓毒症有一定的预测价值;(2)术后血清su PAR水平对术后脓毒症严重程度有一定的评估作用。

Role of soluble urokinase plasminogen activator receptor in predicting postoperative sepsis and predicting prognosis in patients with traumatic colon rupture

Objective By dynamically determining the level of soluble urokinase type plasminogen activa-tor receptor(suPAR)in the patients with traumatic colon rupture,to explore the relationship between preoperative serum suPAR level and abdominal secondary infection and the value for severity assessment of these patients'postop-erative serum suPAR for postoperative secondary abdominal infection.Methods Totally 55 patients(37 males and 18 females)with traumatic colon rupture,who were treated in Emergency Surgery of the Second Affiliated Hospital of Anhui Medical University from Mar.2016 to Sep.2017 were selected.And based on whether the patients had sepsis or not,these patients were divided into sepsis group and non-sepsis group.The sepsis group was divided into sepsis group and septic shock group based on the severity of infection.The level of serum suPAR, interleukin-6(IL-6), and C-reactive protein(CRP)were determined and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score were assessed at the admission,and at 24h,48h,72h after operation.The differences between each set of indicators and these factors'predictive value for abdominal infection of these patients after operation were compared.Results The levels of sepsis group's preoperative and postoperative serum suPAR were significantly higher than those in non-sepsis group((4.63 ±3.19)ng/mL vs.(10.38 ±4.32)ng/mL,P<0.05;(5.21 ±3.98)ng/mL vs. (12.47 ±4.87)ng/mL,P <0.05).The levels of septic shock patients'serum suPAR were also significantly higher than those of sepsis patiens((14.48 ±3.99)ng/mL vs.(8.47 ±3.14)ng/mL,P<0.05).Conclusion (1)The level of serum suPAR in patients with traumatic rupture of colon has certain predictive value for predicting postopera -tive sepsis.(2)The serum level of suPAR in patients after operation has the value in severity assessment for sepsis.