多器官功能障碍综合征患者高级氧化蛋白产物的表达及其临床意义

目的 探讨高级氧化蛋白产物(AOPP)在多器官功能障碍综合征(MODS)发病中的作用及临床意义.方法 选择全身炎症反应综合征(SIRS)和MODS患者各90例.采用分光光度计法测定患者静脉血中C-反应蛋白(CRP)和AOPP的浓度;同时对MODS患者进行急性生理学与慢性健康状况评分系统Ⅲ(APACHE Ⅲ)评分,追踪患者1个月内的生存或死亡情况;分析CRP和AOPP浓度与器官功能障碍程度和病情转归的关系.以同期90例与患者年龄、性别相匹配的健康体检者作为健康对照组.结果 MODS组患者血CRP(22.22±4.32)mg/L3和AOPP(130.66±18.08)μmol/L]浓度均显著高于健康对照组(2.38±0.89)mg/L和(33.20±5.32)μmol/L3和SIRS组(5.32±1.22)mg/L和(48.58±6.03)μmol/L],差异均有统计学意义(P均<0.05),健康对照组与SIRS组间差异无统计学意义.MODS组中死亡患者(47例)血CRP和AOPP浓度显著高于存活患者(43例,P均<0.05);MODS患者血CRP、AOPP浓度与APACHE Ⅲ评分E(98.66±20.87)分]均呈高度正相关(rl=0.469,r2=0.528,P均<0.01).血CRP、AOPP浓度随衰竭器官数增加而明显升高(P均<0.05),AOPP浓度与CRP呈高度正相关(r=0.448,P<0.01).结论 AOPP可能参与了MODS的发病过程,AOPP浓度异常增高反映MODS患者体内存在严重氧化应激状态,可作为判断MODS患者器官功能障碍程度和预后的重要指标.

The expression and clinical implication of advanced oxidized protein products in patients with multiple organ dysfunction syndrome

OBJECTIVE: To investigate the expression and clinical implication of advanced oxidized protein products (AOPP) in patients with multiple organ dysfunction syndrome (MODS). METHODS: Serum concentrations of C-reactive protein (CRP) and AOPP were determined in 180 patients with systemic inflammatory response syndrome (SIRS) or MODS (90 patients, respectively). The acute physiology and chronic health evaluation III (APACHE III) scoring system was applied to assess severity of patients' condition. The contents of serum CRP and AOPP in MODS group, SIRS group and normal control group, and also in survivor and dead patients in MODS group were determined and compared. The correlation between CRP and AOPP levels and the correlation between AOPP levels and severity of MODS were also observed. Ninety healthy volunteers who matched with study subjects in age and gender comprised the normal control group. RESULTS: The CRP (22.22+/-4.32) mg/L] and AOPP (130.66+/-18.08) mumol/L] levels in patients with MODS were significantly higher than those in normal control group (2.38+/-0.89) mg/L and (33.20+/-5.32) mumol/L, respectively] and SIRS group (5.32+/-1.22) mg/L and (48.58+/-6.03) mumol/L, respectively, all P<0.05], and were positively correlated with APACHE III scores (98.66+/-20.87) scores] of the patient (r(1)=0.469, r(2)=0.528, both P<0.01). However, there was no significant difference between SIRS group and normal control group. The CRP and AOPP levels were found to be significantly higher in the patients who eventually died (47 cases) as compared to those in the patients who survived (43 cases, both P<0.05). Positive correlations were noted between AOPP and CRP level (r=0.448, P<0.01). The serum concentrations of CRP and AOPP levels were elevated with the increase of the number of failed organs in MODS patients(all P<0.05). CONCLUSION: The data show that AOPP might participate in the process of pathogenesis of MODS. The serum AOPP level may be taken as a diagnostic and prognostic indicator for MODS.