危重病患者血中生长抑素水平检测的临床意义  

Clinical implication of blood somatostatin determination in critically ill patients

作　　者：吴浩[1] 邓一芸[2] 康焰[2] 黄明慧[1] 胡玲[1] 唐承薇[1] 

机构地区：[1]四川大学华西医院消化内科,成都610041 [2]四川大学华西医院ICU,成都610041

出　　处：《中国危重病急救医学》2009年第5期307-310,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金重点项目（30330270）

摘　　要：目的探讨危重病患者血中生长抑素（SST）水平与机体炎症反应和病情严重度的关系以及对预后的评估价值。方法选择60例急性生理学与慢性健康状况评分系统I（APACHEⅡ）评分≥8分的危重病患者，按照APACHEⅡ评分分为3组：轻度组（〈16分）23例，中度组（16～20分）20例，重度组（〉20分）17例；按预后分为死亡组（13例）与存活组（47例）。另选择20例健康自愿者作为对照。用放射免疫法检测血中SsT水平；用酶联免疫吸附法（ELLSA）检测血中肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）水平。结果危重病组患者血中SST水平明显低于健康对照组[（18．2±17．6）ng／L比（224．8±130．2）ng／L，P〈0．053；TNF—α、IL-6水平明显高于健康对照组[TNF—α（32．4±14．2）ng／L比（14．2±5．7）ng／L，IL-6：（131．6±42．7）ng／L比（65．8±24．3）ng／L，P均〈0．053；SST与TNF—α、IL-6水平均呈显著负相关（r1=0．682，r2—0．894，P均〈0．01）。重度组血中SST水平明显低于轻、中度组（（8．1±7．2）ng／L比（24．7±15．9）ng／L、（19．2±22．1）ng／L，P均〈0．053；TNF—α、IL-6水平明显高于轻度组[TNF—α（39．0±16．4）ng／L比（28．9±10．9）ng／L，IL-6：（156．0±49．6）ng／L比（111．5±32．6）ng／L，P均〈0．053；SST水平与APACHEⅡ评分呈显著负相关（r=-0．327，P〈0．05）。死亡组血中SST水平明显低于存活组（（6．4±5．5）ng／L比（21．5±18．4）ng／L，P〈O．053；TNF—α、IL-6水平虽高于存活组，但差异均无统计学意义。结论危重病患者血中SST水平可以反映病情严重程度，对评估患者预后也具有临床价值。Objective To investigate the relationship between contents of blood somatostatin （SST） and inflammatory reaction or severity of illness in critically ill patients, and its value in the evaluation of prognosis. Methods Sixty critically ill patients were divided into three groups according to the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score as mild （〈16, 23 cases）, mediate （16-20, 20 cases） and severe （〉20, 17 cases） group; and also divided as dead （D, 13 cases） or survival group （S, 47 cases） according to the final outcome; 20 healthy volunteers served as control. The blood SST concentration was detected by radioimmunity, while the levels of tumor necrosis factor-α （TNF-α） and interlukin-6 （IL-6） were measured by enzyme linked immunosorbent assay （ELISA）. Results The SST concentration in critically ill patients was significantly lower than normal control [（18.2±17.6） ng/L vs. （224.8±130. 2） ng/L, P〈0. 053, while the levels of TNF-α and IL-6 were significantly higher [TNF-α （32.4±14.2） ng/L vs. （14.2±5.7） ng/L, IL-6（131.6± 42.7） ng/L vs. （65.8±24.3） ng/L, both P〈0. 053. The SST concentration in severe group was significantly lower than that of mild and mediate group [（8. 1±7.2） ng/L vs. （24. 7±15.9） ng/L and （19.2±22.1） ng/L, both P〈0. 053, while the levels of TNF-α and IL-6 were significantly higher than mild group [TNF-α （39.0± 16.4） ng/L vs. （28.9± 10. 9） ng/L, IL-6： （156.0±49.6） ng/L vs. （111.5±32.6） ng/L, both P〈0. 053. A negative correlation was found between SST and TNF-α, IL-6, also between SST and APACHE Ⅱ score （Ⅱ= 0. 682, r2=- 0. 894, r3= 0. 327, P〈0. 05 or P〈0. 01）. The SST concentration in D group was significantly lower than S group[（6. 4±5.5） ng/L vs. （21.5±18. 4） ng/L, P〈0. 05）] Conclusion The SST level in blood can reflect the severity of illness in critically ill patients and shows clinical value in evaluation of prognosis

关 键 词：生长抑素 急性生理学与慢性健康状况评分系统Ⅱ评分 细胞因子 危重病 

分 类 号：R686[医药卫生—骨科学]