重组人促血小板生成素改善脓毒症患者心肌损伤的临床研究

目的探讨脓毒症患者使用重组人促血小板生成素治疗后心肌损伤标志物、心功能、炎症因子水平等变化规律，以判断其对临床预后的作用。 方法选择上海市第一人民医院急诊危重症医学科病房2016年1月至2019年4月收治的符合Sepsis3.0诊断标准的脓毒症患者186例，根据是否使用重组人促血小板生成素(rhTPO)将其分为对照组和rhTPO组。收集基本信息资料、临床数据资料、炎症因子和免疫功能指标预后生存状态等，主要监测指标为患者心肌损伤标志物TnI和心功能BNP，次要监测指标为炎症因子IL-6和TNF-α。 结果使用rhTPO患者第七天心肌损伤指标血清心肌坏死标记物：心肌肌钙蛋白I(TnI)较未使用rhTPO患者下降幅度大(0.6471±0.4145 vs. 0.2517±0.1347μg/L，P＝0.006) ；使用rhTPO患者第七天心功能指标脑钠肽BNP较未使用rhTPO患者下降幅度大(529.4±251.1 vs. 306.1±53.52 pg/ml，P<0.0001)。rhTPO可以降低反映内皮损伤的炎症因子IL-6、TNF-α。使用rhTPO患者第七天炎症指标IL-6较未使用rhTPO患者下降幅度明显增大(843.3±514.0 vs. 357.1±84.71 pg/ml，P<0.0001)。使用rhTPO患者第七天炎症指标TNF-α较未使用rhTPO患者下降幅度明显增大(9.771±9.051 vs. 5.850±1.621 pg/ml, P<0.0001)。 结论rhTPO可以改善脓毒症心肌损伤、心功能，改善脓毒症炎症指标。

Effects of recombinant human thrombopoietin in improving myocardial injury in patients with sepsis

Objective To investigate the changes of myocardial injury markers,cardiac functions and inflammatory cytokines in the patients with sepsis treated with recombinant human thrombopoietin(rhTPO),and to determine its effects on the clinical prognosis.Methods In this study,the patients with sepsis who met Sepsis 3.0 diagnostic criteria were collected from the Emergency Critical Care Medical Ward of Shanghai First People′s Hospital from January 2016 to April 2019 by retrospective observation method.According to whether they were treated with rhTPO,they were divided into an rhTPO group and a control group.The basic information,clinical data,inflammatory factors,indexes of immune functions,and prognosis conditions were collected.The main monitoring indexes for the patients were the myocardial injury marker Troponin I(TnI)and the cardiac function marker brain natriuretic peptide(BNP).The secondary monitoring indexes were inflammatory cytokines interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α).Student′s t test was employed to treat the normal distribution data,the nonparametric test was employed to treat the abnormal distribution data,and Chi square test or Fisher inspection methods were employed to treat the counting data.And differences between the two groups were compared.Results A total of 186 patients with sepsis were included in this study,including 26 patients in the rhTPO group and 160 patients in the control group.On the 7th day of treatment of rhTPO,TnI(0.2517±0.1347 g/L in the rhTPO group vs.0.6471±0.4145 g/L in the control group,P=0.006),BNP(306.1±53.52 pg/ml in the rhTPO group vs.529.4±251.1 pg/ml in the control group,P<0.0001),IL-6(357.1±84.71 pg/ml in the rhTPO group vs.843.3±514.0 pg/ml in the control group,P<0.0001),and TNF-α(5.850±1.621 pg/ml in the rhTPO group vs.9.771±9.051 pg/ml in the control group,P<0.0001)showed significant decreases in the patients of the rhTPO group compared with the patients in the control group.Conclusion The rhTPO can improve the myocardial injury,the cardiac functions and the inflammatory indexes of sepsis.