脓毒症患者血管内皮功能的细胞标记物检测

目的 探讨脓毒症病程中循环内皮细胞(CEC)和内皮细胞微粒(EMP)数量的变化特点及其与炎症因子的关系.方法 选择脓毒症患者,按确诊当日急性生理学与慢性健康状况评分系统II(APACHE II)评分分为轻度(＜9分)、中度(9～15分)和重度(＞15分)组,各组再按病情转归分为存活组及死亡组.于患者入院后1、2、3、7、14 d采血,共采集127份血标本,用流式细胞仪检测血中CEC和EMP数量,用酶联免疫吸附试验(ELISA)双抗体夹心法测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-4和IL-10的含量.结果 ①随着脓毒症病情的加重,EMP、TNF-α及IL-1β均显著增高(P＜0.05或P＜0.01).中度组CEC及IL-10均较轻度组增高,重度组CEC显著低于轻、中度组(P＜0.05或P＜0.01),轻、中、重度组间IL-4及IL-10比较差异均无统计学意义.②死亡组及存活组CEC及EMP均随病情程度加重而升高;其中死亡组EMP及促炎因子均显著高于相同病情存活组(P＜0.05或P＜0.01),而CEC及抗炎因子均显著低于相同病情存活组(P＜0.05或P＜0.01).结论 脓毒症患者随病情加重CEC及EMP水平明显增加,可作为反映病情严重程度的指标,且可用于判断预后.

Studies on the cell markers of endothelial function in sepsis

Objective To study the phasic changes of the number of circulating endothelial cells (CEC) and endothelial microparticles(EMP)during the process of sepsis.Methods Thirty-one patients with sepsis were divided into mild group(<9),moderate group(9-15)and severe group(>15)according to the acute physiology and chronic health evaluation II(APACHE II)scores after onset,and each group was further divided into survivors and non-survivors.The level of CEC,EMP and pro-inflammatory cytokines were determined on 1,2,3,7,14 days after onset.Results ① The level of EMP,tumor necrosis factor-α (TNF-α)and interleukin-16(IL-1β)in the severe group were significantly higher than the mild group and moderate group(P<00.05 or P<0.01).The number of CEC in the severe group was significantly lower than the mild group and moderate group(P<0.05 or P<0.01).② The levels of CEC,EMP in the non-survivor and the survivor group were significantly higher with sepsis increased significantly;and the levels of EMP,pro-inflammatory in the non-survivor group were significantly higher than those of the survivor group(P<0.05 or P<0.01),but the。levels of CEC,IL-4 and IL-10 in non-survivors were significantly lower than the survivors(P<0.05 or P<0.01).Conclusion The Ievels of CEC and EMP in patients with sepsis increased significantly.They can not only serve as an index to reflect the severity of sepsis,but also have fl prognostic value in patients with sepsis.