脓毒症患者急性时相蛋白的动态联合检测

目的　研究血清急性时相蛋白水平在脓毒症和重度脓毒症患者炎症过程中的变化及其临床意义。方法　采用全自动特定蛋白定量分析方法,分组动态测定1、3、7、1 4和2 1 d 5个时间点2 9例脓毒症( SP)组和2 7例重度脓毒症( SSP)组患者的C反应蛋白( CRP)、a1酸性糖蛋白( AAG)、铜蓝蛋白( CER)以及结合珠蛋白( HP)的血清含量,并与3 0例健康体检者进行对照分析。结果　1 SP组:CRP和AAG在炎症早期1 d内就显著升高( P<0 .0 1和P<0 .0 5) ,其中CRP3 d达高峰,AAG3～7d达高峰,AAG持续高峰时间达1 4 d,CRP和AAG各时间点间差异显著( P均<0 .0 1 ) ;CER无显著升高( P>0 .0 5) ,各时间点差异不显著( P>0 .0 5) ;HP早期也显著升高( P<0 .0 5) ,但各时间点差异无显著性( P>0 .0 5)。2 SSP组:CRP和AAG均显著升高( P均<0 .0 1 ) ,高峰持续时间均长达1 4 d,各时间点间差异非常显著( P<0 .0 1 ) ;CER7d前呈下降趋势( P<0 .0 5) ,各时间点间差异有显著性( P<0 .0 5) ;HP在1 4 d才显著升高,2 1 d达峰值( P均<0 .0 5) ,各时间点间差异有显著性( P<0 .0 5)。组间趋势变化比较:CRP、AAG和HP差异均有显著性( P均<0 .0 5) ,CER差异无显著性( P>0 .0 5)。结论　CRP早期升高是感染的敏感指标,CRP和AAG高峰持续时间延长提示重度感染;HP不升

Clinical study of dynamic changes in acute phase proteins in sepsis

Objective To investigate the significance of changes in plasma levels of acute phase proteins (APPs) in patients with sepsis and severe sepsis by serial analysis. Methods Plasma contents of C reactive protein (CRP), a1acid glycoprotein (AAG), ceruloplasmin (CER) and haptoglobin(HP) were determined by quantitative analysis in 29 sepsis and 27 severe sepsis patients on 1, 3, 7, 14 and 21 days using an American made specified protein automatic analyzer IMMAGE. The data were compared with those of 30 healthy persons. Results In sepsis group. CRP and AAG levels were found to be significantly increased on 1 day ( P <0.01 and P <0.05). CRP level peaked on 3 days, while that of AAG peaked on 3 to 7 days. The peak of AAG level maintained for 2 weeks. There were significant differences in levels of CRP and AAG at different time points (both P <0.01). CER level was not increased ( P >0.05). HP level increased significantly early ( P <0.05), but there was no difference in HP between different time intervals ( P >0.05). In severe sepsis group there was very marked increase in CRP and AAG different time intervals (both P <0.01 ). The high levels maintained for 14 days. There was significant difference in CRP and AAG levels between different time intervals ( P <0.01).CER showed a tendency of lowering , and significant difference was found among different time points ( P <0.05). HP did not increase significantly before 14 days ( P >0.05) followed by a slow increase with significant difference among different time points ( P <0.05). A comparison of tendency of changes between groups were significant differences in CRP, AAG and HP (all P <0.05) . There was no significant difference in CER ( P >0.05). Conclusion Early increase in CRP was a sensitive sign for infection . The extended peaking of CRP and AAG levels indicates severe infection . Absence of increase in HP, or a reduction of it suggests also the presence of severe infection. CER is not a sensitive indicator of severity of infection.