脓毒症患者病情严重程度与血浆可溶性Fas受体、可溶性Fas配体及基质金属蛋白酶7水平相关性研究

目的探讨早期脓毒症患者血浆中可溶性Fas受体(sFas)、可溶性Fas配体(sFas-L)及基质金属蛋白酶7(MMP-7)水平与患者病情严重程度及预后的关系。方法采用酶联免疫吸附(ELISA)法测定并比较32例脓毒症患者及24例年龄性别匹配的健康对照组血浆中sFas、sFas-L、sFas/sFas-L比值和MMP-7的水平差异。根据脓毒症患者的28 d预后不同分为生存组和死亡组,比较两组之间各指标的差异。结果脓毒症患者血浆sFas、sFas-L和MMP-7水平均较正常对照组明显升高,差异均具有统计学意义(P均<0.01)。sFas和sFas-L与患者疾病严重程度评分急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)及序贯器官衰竭(SOFA)呈正相关。MMP-7与APACHEⅡ评分、SOFA评分之间存在较弱的负相关,但无统计学意义(P>0.05)。与存活患者相比,死亡患者血浆中的sFas-L水平明显升高,而sFas/sFas-L比值则明显降低(P<0.05)。结论脓毒症患者病情严重程度与血浆中sFas、sFas-L及MMP-7水平密切相关,这些指标有望成为判断脓毒症预后的生物标志物。

Elevated Plasma sFas, sFas-L and Matrix Metalloproteinase-7 Levels in Sepsis and their Correlation with the Severity of Sepsis

Objective To investigate the plasma levels of soluble Fas receptor （sFas）, soluble Fas ligand （sFas-L） and matrix metalloproteinase-7 （MMP-7） and their correlation with disease severity as well as the prognosis of septic patients. Methods The plasma levels of sFas, sFas-L, sFas/sFas-L ratio and MMP-7 were measured by enzyme-linked immunosorbent assay and compared between 32 patients with sepsis and 24 age and sex matched healthy controls. Based on the 28-day outcome, the patients were divided into a survival group and a death group. The difference in sFas, sFas-L, sFas/sFas-L ratio and MMP-7 between the survival group and the death group were compared. Results Compared with the healthy control group, the concentration of plasma sFas, sFas-L and MMP-7 were significantly increased in the septic patients （ P 〈 0. 01 ）. Elevated plasma sFas and sFas-L were both positive correlated with the APACHE Ⅱ score and SOFA score. Although a modest negative correlation was found between plasma MMP-7 and APACHE Ⅱscore and SOFA score, but this correlation did not reach statistical significance （ P 〉 0.05 ）. The septic patients who died had significantly higher sFas-L level and lower sFas/sFas-L ratio as compared with those who survived （ P 〈 0. 05 ）. Conclusion Plasma sFas, sFas-L and MMP-7 are associated with the disease severity and can serve as potential markers for predicting the outcome in septic patients.