脓毒症患者血管性假血友病因子、血栓调节蛋白变化及乌司他丁的干预作用

目的观察脓毒症患者血管内皮细胞(VEC)分泌血管性假血友病因子(vWF)、血栓调节蛋白(TM)的变化及乌司他丁的干预作用。方法选择脓毒症患者56例,分为治疗组(n=27)及乌司他丁组(n=29),两组均给予常规治疗,乌司他丁组加用乌司他丁静脉注射每12小时1次,连续10天;选取健康体检者作为对照组(n=20)。检测研究对象治疗前后外周血血清vWF、TM的水平;利用脓毒症患者血清作用于体外培养的VEC株(CRL-1730),检测培养上清液中可溶性vWF、TM的水平,并观察乌司他丁对培养上清液中vWF、TM水平的影响。结果治疗前,治疗组vWF、TM水平分别为(126.6±19.3)%,(29.8±5.6)μg/L;乌司他丁组vWF、TM水平分别为(128.3±6.3)%,(31.7±2.1)μg/L,两组患者vWF、TM水平与对照组比较均升高(均P0.05);治疗后,两组患者vWF、TM水平均下降,治疗组vWF、TM水平分别为(102.6±31.3)%,(18.9±3.6)μg/L;乌司他丁组vWF、TM水平分别为(80.6±26.3)%,(15.1±4.3)μg/L,治疗后乌司他丁组与治疗组比较差异有统计学意义(均P0.05);体外实验中,经乌司他丁干预后,细胞培养上清液中vWF、TM水平明显下降,分别为(67.1±21.6)%,(13.3±2.5)μg/L,与治疗组比较差异有统计学意义(均P0.01)。结论脓毒症患者存在VEC的损伤,乌司他丁对脓毒症患者的VEC损伤有保护作用。

Influence of ulinastatin on von Willebrand factor and thrombomodulin in patients with sepsis

Objective To evaluate the influence of ulinastatin on von Willebrand factor（vWF）and thrombomodulin（TM）of vascular endothelial cells（VEC）of patients with sepsis.Methods Fify-six sepsis patients were divided into therapy group（n =27）and ulinastatin group（n =29）.Both groups were treated with routine treatment while the ulinastatin group treated with ulinastatin（injection per 12 hours,10dcontinuously）in addition.The levels of serum vWF and TM of the sepsis patients before and after 10days′treatment with ulinastatin were detected.The VEC（CRL-1730）strains in vitro were cultivated with the serum of the sepsis patients,and the levels of vWF and TM in the supernatant before and after the intervening of ulinastatin were detected.Results Before treatment,the vWF and TM were higher in the serum of the sepsis patitents than those in the healthy group,the vWF was（126.6±19.3）%,and the TM was（29.8±5.6）μg/L in the therapy group,while the vWF was（128.3±6.3）%,and the TM was（31.7±2.1）μg/L in the ulinastatin group.After the treatment,the vWF and TM of both the therapy group and the ulinastatin group were decreased,the vWF was（102.6±31.3）%,and the TM was（18.9±3.6）μg/L in the therapy group,while the vWF was（80.6±26.3）%,and the TM was（15.1±4.3）μg/L in the ulinastatin group.The ulinastatin group compared with the therapy group showed statistical significance（P〈 0.05）.The vWF and TM in the supernatant were decreased significantly in the ulinastatin group（P 〈0.01）,and the vWF was（67.1±21.6）%,the TM was（13.3±2.5）μg/L after the intervening of ulinastatin.Conclusion Ulinastatin can protect VEC injury in sepsis patients.