血栓调节蛋白和基质金属蛋白酶在脓毒症及多器官功能障碍综合征中的意义

目的检测脓毒症患者血浆血栓调节蛋白(TM)和基质金属蛋白酶9(MMP9)水平,探讨它们对多器官功能障碍综合征(MODS)早期诊断和预后判断的意义。方法采用酶联免疫吸附测定法(ELISA)连续监测32例ICU中脓毒症患者血浆TM和MMP9浓度的动态变化,并选择15例同期健康体检者作为对照。结果与对照组比较,所有患者的血浆TM及MMP9均呈不同程度的升高(P<0.01)。发生MODS患者的TM、MMP9水平比非MODS患者明显升高(P<0.05或P<0.01)。在MODS患者中,非生存组比生存组TM、MMP9升高更明显且持续时间更长(P<0.01)。结论内皮细胞及其细胞外基质的损伤在脓毒症MODS的病理过程中起着重要的作用。TM和MMP9联合应用有助于MODS的早期诊断及其预后的判断。

Significance of thrombomodulin and matrix metalloproteinase-9 in sepsis and multiple organ dysfunction syndrome

Objective To investigate the changes of thrombomodulin and matrix metalloproteinase-9 in sepsis and determine their significance in the early diagnosis and prognosis of multiple organ dysfunction syndrome. Methods The plasma levels of thrombomodulin and matrix metalloproteinase-9 in 32 ICU patients with sepsis were measured by immunofluorescence. Results Compared with control group,the levels of TM and MMP-9 were significantly higher on the day of the diagnosis of sepsis(P<0.01) and continued to show markedly high values in patients with MODS (P<0.05 or P<0.01). In the MODS patients,levels of TM and MMP-9 were persistently higher in the nonsurvivors than in the survivors during the study period(P<0.01). A positive correlation was also observed between plasma TM levels and the MMP-9 (P<0.01).Conclusion The damage of endothelium and extracellular matrix played a vital role in the pathogenesis of sepsis and MODS. TM and MMP-9 were good predictors of organ dysfunction and also of a poor prognosis.