严重创伤合并失血性休克患者血浆肾上腺髓质素及内皮素含量的变化  

The increase of plasma adrenomedullin and endothelin levels in patients with serious injuries complicated by hemorrhagic shock

作　　者：周华满[1] 缪英年[1] 刘国奋[1] 欧武剑[1] 

机构地区：[1]广州中医药大学附属中山市中医院急诊科骨创组,广东中山528400

出　　处：《中国医师杂志》2006年第10期1339-1342,共4页Journal of Chinese Physician

摘　　要：目的探讨严重创伤合并失血性休克患者血浆肾上腺髓质素(ADM)、内皮素-1(ET-1)含量变化的临床意义。方法用放射免疫分析法测定74例严重创伤其中38例合并失血性休克患者早期血浆ADM、ET-1含量,并分别与36例无失血性休克患者和30例年龄、性别匹配的健康人对照。结果严重创伤患者血浆ADM、ET-1含量均明显增高,各组含量均明显高于正常对照组;尤其是休克组又明显高于无休克组,轻、中、重度休克组也明显高于无休克组;轻、中、重度休克组逐级递增,3组间相互比较差异均有统计学意义(P<0.05)。休克组患者血浆ET-1/ADM比值也有类似变化,并按轻、中、重度休克逐级递增。休克组、无休克组患者血浆ADM含量增高分别与ET-1含量增高均呈呈正相关(r=0.492,0.438,P<0.01)。结论严重创伤,尤其是合并失血性休克患者血浆舒血管活性肽ADM含量明显增高,可能是机体的一种代偿性自身调节机制,以此抑制ET-1等缩血管活性肽增高对机体产生不良的影响,对机体起到自身保护性代偿作用。但其变化的确切机制,尚待深入研究。Objective To investigate the clinical significance of the plasma adrenomedullin （ADM） and endothelin（ ET-1 ） concentrations in patients with serious injuries complicated by hemorrhagic shock. Method Plasma ADM and ET-1 concentrations were measured by radioimmunoassay in 38 hemorrhagic shock patients（ A group）and 36 non-hemorrhagic shock patients（ B group）among 74 serious injury patients in the early stage and 30 age-sex-matched healthy （ C group） control subjects. Results Plasma ADM and ET-1 concentrations in B group and A group, including miht （A1 group）, middle （A2 group） and serious（ A3 group） hemorrhagic shock patients were significantly higher than those of C group. The plasma ADM and ET-1 levels were greatly higher in A group than in B group. Their levels in A1, A2 and A3 groups were progressively increased. There were statistical differences between A1 and A2 group, A1 and A3 group, A2 and A3 group respectively. There were similar increases of the plasma ET-1/ADM ratio in A group, and the ratios in A1 , A2 and A3 group were progressively increased also. There were positive correlations between increased plasma ADM levels and the increased plasma ET-1 levels in both A group and B group patients（ r = 0. 492,0. 438, P 〈 0. 01 ）. Conclusions Plasma vascular diastolic peptide ADM concentrations in serious injury patients, especially the patients complicated by hemorrhagic shock are markedly higher than those of the healthy control group. It may be a possible mechanism of compensational self-regulation of the body. So, inhibiting vascular systolic peptides such as ET-1 etc. could exert an unfavorable influence upon the body. However, the exact roles of plasma ADM and ET-1 in the pathogenesis of patients with serious injuries complicated by hemorrhagic shock require further studies.

关 键 词：休克 创伤性 肾素 内皮缩血管肽1 

分 类 号：R641[医药卫生—外科学]