内毒素增敏系统与严重烧伤脓毒症的关系及其临床意义  

Relationship between sensitization system of endotoxin and severe burn sepsis and its clinical significance

作　　者：董宁[1] 姚咏明[1] 于燕[1] 曹玉珏 贺立新 盛志勇[1] 

机构地区：[1]解放军总医院第一附属医院全军烧伤研究所,北京100048 [2]北京佑安医院烧伤科,北京100054

出　　处：《解放军医学杂志》2011年第1期21-23,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家重点基础研究发展计划(2005CB522602);国家自然科学基金(30872683);首都医学发展基金重点项目(2003-2023)

摘　　要：目的探讨严重烧伤患者内毒素增敏系统——脂多糖结合蛋白/脂多糖受体CD14(LBP/CD14)的变化与严重脓毒症的关系及其临床意义。方法选择35例烧伤体表总面积大于30%患者,根据烧伤脓毒症的定义和诊断标准分为脓毒症组(19例)和非脓毒症组(16例),应用酶联免疫吸附试验检测患者烧伤后1、3、5、7、14、21、28d血浆LBP、可溶性CD14(sCD14)及白细胞介素6(IL-6)的水平。另选择11例健康献血员作为正常对照组。结果与正常对照组比较,严重烧伤患者伤后血浆LBP、sCD14及IL-6水平均有显著升高(P<0.01),并发脓毒症的患者血浆LBP水平在伤后3、14、21、28d较未发生脓毒症患者明显升高,血浆sCD14及IL-6水平在烧伤后特别是14～28d显著高于非脓毒症患者(P<0.05或P<0.01),且与LBP水平呈明显正相关(P<0.05或P<0.01)。结论严重烧伤后内毒素增敏系统参与了脓毒症的病理生理反应。动态监测循环LBP/CD14的变化有助于了解脓毒症的发生与发展过程。Objective To explore the relationship between the changes of lipopolysaccharide-binding protein（LBP） and CD14 as a sensitization system of endotoxin and severe burn sepsis,and investigate the clinical significance of the relationship.Methods Thirty-five severe burn patients（〉30% TBSA） were involved in present study and divided into sepsis group（n=19） and non-sepsis group（n=16） based on the definition and diagnosis standard of sepsis.The blood samples were collected on day 1,3,5,7,14,21 and 28 after burn and the plasma levels of LBP,soluble CD14（sCD14） and interleukin-6（IL）-6 were measured by enzyme-linked immunosorbent assay（ELISA）.Eleven healthy blood donors were chosen as controls.Results Plasma levels of LBP,sCD14 and IL-6 were markedly elevated in severe burn patients compared with those in controls（P〈0.01）.LBP levels were significantly higher in sepsis group than in non-sepsis group on day 3,14,21 and 28 after burn（P〈0.05 or 0.01）.Plasma levels of sCD14 and IL-6 elevated significantly in sepsis group than in non-sepsis group during later stage,especially on day 14 to 28 after burn（P〈0.05 or 0.01）.In addition,there existed a significant positive correlation between sCD14/IL-6 and LBP levels（P〈0.05 or 0.01）.Conclusions Endotoxin sensitization system participates in the postburn pathophysiological processes.Dynamically monitoring the levels of LBP and sCD14 may be helpful to understand the development of postburn sepsis.

关 键 词：烧伤 脂多糖结合蛋白 抗原 CDI4 细胞因子类 脓毒症 

分 类 号：R644.023[医药卫生—外科学]