危重病患者血中生长抑素水平检测的临床意义

目的 探讨危重病患者血中生长抑素(SST)水平与机体炎症反应和病情严重度的关系以及对预后的评估价值.方法 选择60例急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分≥8分的危重病患者,按照APACHE Ⅱ评分分为3组:轻度组(<16分)23例,中度组(16～20分)20例,重度组(>20分)17例;按预后分为死亡组(13例)与存活组(47例).另选择20例健康自愿者作为对照.用放射免疫法检测血中SST水平;用酶联免疫吸附法(ELISA)检测血中肿瘤坏死因子-α(TNF-α)、白细胞介索-6(IL-6)水平.结果 危重病组患者血中SST水平明显低于健康对照组(18.2±17.6)ng/L比(224.8±130.2)ng/L,P<0.053;TNF-α、IL-6水平明显高于健康对照组TNF-α:(32.4±14.2)ng/L比(14.2±5.7)ng/L,IL-6:(131.6±42.7)ng/L比(65.8±24.3)ng/L,P均<0.053;SST与TNF-α、IL-6水平均呈显著负相关(r1=-0.682,r2=-0.894,P均<0.01).重度组血中SST水平明显低于轻、中度组C(8.1±7.2)ng/L比(24.7±15.9)ng/L、(19.2±22.1)ng/L,P均<0.053;TNF-α、IL-6水平明显高于轻度组TNF-α:(39.0±16.4)ng/L比(28.9±10.9)ng/L,IL-6:(156.05=49.6)ng/L比(111.5±32.6)ng/L,P均<0.053;SST水平与APACHE Ⅱ评分呈显著负相关(r=-0.327,P<0.05).死亡组血中SST水平明显低于存活组(6.4±5.5)ng/L比(21.5±18.4)ng/L,P<0.053;TNF-α、lL-6水平虽高于存活组,但差异均无统计学意义.结论 危重病患者血中SST水平可以反映病情严重程度,对评估患者预后也具有临床价值.

Clinical implication of blood somatostatin determination in critically ill patients

Objective To investigate the relationship between contents of blood somatostatin(SST) and inflammatory reaction or severity of illness in critically ill patients,and its value in the evaluation of prognosis.Methods Sixty critically ill patients were divided into three groups according to the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score as mild(<16,23 cases),mediate(16～20, 20 cases)and severe(>20,17 cases)group;and also divided as dead(D,13 cases)or survival group (S,47 cases)according to the final outcome ;20 healthy volunteers served as control.The blood SST concentration was detected by radioimmunity,while the levels of tumor necrosis factor-α(TNF-α)and interlukin-6(IL-6)were measured by enzyme linked immunosorbent assay(ELISA).Results The SST concentration in critically ill patients was significantly lower than normal control(1 8.2±l 7.6)ng/L vs. (224.8±130.2)ng/L,P<0.053,while the levels of TNF-α and IL-6 were significantly higherTNF-α: (32.4±14.2)ng/L VS.(14.2±5.7)ng/L,IL-6:(131.6±42.7)ng/Lvs.(65.8±24.3)ng/L,both P<0.05].The SST concentration in severe group was significantly lower than that of mild and mediate group (8.1±7.2)ng/L vs.(24.75:15.9)ng/L and(19.2±22.1)ng/L,both P<0.05],while the levels of TNF-α and IL-6 were significantly higher than mild groupTNF-α:(39.0±16.4)ng/L vs.(28.9± 10.9)ng/L,IL-6:(156.0±49.6)ng/L vs.(111.5±32.6)ng/L,both P<0.05].A negative correlation was found between SST and TNF-α,IL-6,also between SST and APACHE I score(r1=-0.682, r2=-0.894,,r3=-0.327,P<0.05 or P<0.01).The SST concentration in D group was significantly lower than S group(6.4q5.5)ng/L vs.(21.5±18.4)ng/L,P<0.053.Conclusion The SST levelin blood can reflect the severity of illness in critically ill patients and shows clinical value in evaluation of prognosis.