血小板在危重病患者全身炎症反应监测中的意义

目的 :研究血小板在危重病全身炎症反应监测中的意义 ,为全身炎症反应综合征 (SIRS)提供敏感而简易的临床监测指标。方法 :ICU内各种原因所致的 SIRS、脓毒症和多器官功能障碍综合征 (MODS)患者 2 13例 ,按临床结局将患者分为死亡组 (n=6 2 )和存活组 (n=15 1)。入院后当天和第 3d、7d、10 d进行急性生理学和慢性健康状况评分 (APACHE )、血常规和外周血中肿瘤坏死因子α(TNFα)检测。结果 :入 ICU时存活组和死亡组 APACHE 评分明显增高 ,但无显著差异 ;治疗 7d和 10 d后 ,存活组下降至 10分以下 ,而死亡组上升至 2 0分以上 (P<0 .0 1)。血小板计数在入院时两组均降低 ,治疗 3d后有明显回升 ,但在治疗后 7d和 10 d时死亡组患者血小板再度进行性下降 ,而存活组上升至正常范围 (P<0 .0 0 1) ;白细胞总数和分类两组间无显著差异。入院时两组患者外周血中 TNFα的浓度无显著差异 ,3d后两组 TNFα均升高 ;治疗 7d和 10 d后存活组 TNFα水平显著下降 ,而死亡组患者仍维持在相对高的水平 ,两组间有显著性差异 (P均 <0 .0 0 1)。结论 :血小板进行性下降能较正确、敏感地反映全身炎症反应的强弱 ,且其检查快速、简单、易行 ,在临床上有较大的实用价值。

Analysis of platelets in the monitoring of systemic inflammatory response syndrome of critically ill patients

OBJECTIVE: To study the clinical significance of the variance of platelets in systemic inflammatory response syndrome(SIRS) of critical illness. METHODS: Two hundred and thirteen critically ill patients in ICU, who suffered from SIRS, sepsis and multiple organ dysfunction syndrome (MODS), were enrolled in this study and divided into two groups, survivor group (n=151) and non-survivor group (n=62). Platelet, white blood cell counts and acute physiology and chronic health evaluation II (APACHE II) score were performed immediately after hospitalization, 3 days, 7 days, and 10 days later. At the same time, the serum was collected and the level of tumor necrosis factor-alpha (TNF-alpha) was measured. RESULTS: APACHE II score was much higher, but no difference in the two groups immediately after the hospitalization. However, it increased markedly in non-survivor group, and lowered dramatically in survivor group 7 days after therapy. There was a significant difference between the two groups (P<0.01). Platelets were slightly lower in both groups immediately after the hospitalization. After three days' therapy, it increased to the normal range in the two groups. However, it progressively dropped in non-survivor group 7 days and 10 days later, and it was significantly different from survivor group (P<0.001). The white blood cell counts revealed that there was no significant difference between the two groups. The level of TNF-alpha in serum was much higher in both groups immediately after the hospitalization. After three days' therapy, it further increased and was maintained at the high level in the two groups. However, it progressively dropped in survivor group, while it remained in higher level in non-survivor group 7 days and 10 days later, which was significantly different from survivor group (both P<0.001). CONCLUSION: Refractory thrombocytopenia is sensitively responsive to poor prognosis and severity of SIRS in critical illness.