辛伐他汀对脓毒症患者降钙素原、C反应蛋白及预后的影响

目的拟用辛伐他汀干预脓毒症,观察辛伐他汀对脓毒症患者降钙素原(PCT)、C反应蛋白(CRP)及预后的影响,以探索辛伐他汀调节炎症反应的相关机制。方法采用前瞻性随机对照研究,以2013年10月-2016年12月ICU收治的82例脓毒症患者为研究对象并随机分组。测定两组患者入院后体温,血PCT、CRP水平,白细胞计数以及28 d病死率情况;在使用辛伐他汀(40 mg/d)第10天随访患者的肝功能指标丙氨酸转氨酶(ALT)和肌红蛋白(Myo),以评估辛伐他汀对相关脏器功能的影响。结果42例干预组和40例对照组患者年龄、性别、APACHEⅡ评分、入院最高体温、合并心力衰竭、肾功能等均无显著差异。干预组与对照组患者的炎症指标(PCT、CRP)在第3天开始都出现明显的下降,PCT第5天为(4.76±1.58)μg/L与(8.62±2.92)μg/L,P=0.038;第7天为(1.35±0.36)μg/L与(2.79±0.98)μg/L,P=0.017;第10天为(0.45±0.07)μg/L与(1.61±0.48)μg/L,P<0.001。CRP第3天为(81.95±7.63)mg/L与(123.17±12.29)mg/L,P=0.003;第5天为(45.12±4.17)mg/L与(67.93±7.15)mg/L,P=0.006;第7天为(21.73±2.55)mg/L与(34.72±4.81)mg/L,P=0.007等。两组患者28 d病死率无显著差异。两组患者的ALT和Myo随访数据无显著差异。结论辛伐他汀能显著降低脓毒症患者的PCT、CRP等炎症指标,两组患者全因死亡率无差异,希望对临床上干预脓毒症提供新思路。

Effect of simvastatin on procalcitonin,C-reactive protein and outcome of sepsis patients

Objective To investigate the effects of simvastatin on procalcitonin(PCT),C-reactive protein(CRP)and outcome of sepsis patients;and explore the anti-inflammatory mechanism of simvastatin.Methods A prospective randomized controlled trial was carried out.A total of 82 sepsis patients admitted to ICU from October 2013 to December 2016 were enrolled and randomized into conventional treatment group(40 patients)and simvastatin treatment group(42 patients,40 mg/d).Body temperature,serum PCT,CRP level,white blood cell count and 28-day mortality were measured.Liver function tests and myoglobin were followed up on Day 10 of treatment for assessment of the adverse effects of simvastatin.Results No significant difference was found between conventional treatment group and simvastatin treatment group in age,gender,APACHEⅡscore,maximum body temperature at admission,heart failure,and renal function.The inflammation indicators decreased on Day 3 in both groups(simvastatin vs conventional treatment group),including PCT(4.76±1.58)μg/L vs(8.62±2.92)μg/L on D5,P=0.038;(1.35±0.36)μg/L vs(2.79±0.98)μg/L on D7,P=0.017;(0.45±0.07)μg/L vs(1.61±0.48)μg/L on D10,P<0.001];CRP(81.95±7.63)mg/L vs(123.17±12.29)mg/L on D3,P=0.003;(45.12±4.17)mg/L vs(67.93±7.15)mg/L on D5,P=0.006;(21.73±2.55)mg/L vs(34.72±4.81)mg/L on D7,P=0.007].There was no significant difference in mortality between the two groups.Follow-up alanine aminotransferase and myoglobin did not show significant difference between the two treatment groups.Conclusions Simvastatin can significantly reduce the level of inflammatory indicators in sepsis patients,such as PCT and CRP.Simvastatin has no significant effect on 28-day all-cause mortality in sepsis patients.This finding may inform clinical intervention in sepsis.