脂联素在脓毒症中的变化及与疾病严重程度相关性分析  

Changes in plasma adiponectin concentrations in sepsis and its correlation with the severity of the disease

作　　者：龚晓莹[1] 张晓丽[1] 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院重症医学科,辽宁沈阳110004

出　　处：《中国危重病急救医学》2012年第9期541-545,共5页Chinese Critical Care Medicine

基　　金：辽宁省自然科学基金项目（201102293）

摘　　要：目的探讨血浆总脂联素（APN）及高分子脂联素（HAP）在脓毒症中的变化规律、与感染的关系以及对疾病预后的提示意义。方法采用前瞻性研究方法，选择2011年6月至11月本院重症监护病房（ICU）脓毒症患者80例，采用酶联免疫吸附试验（ELISA）检测人ICU2h、2d、6d血浆APN水平（总APN及HAP），并测定降钙素原（PCT）、内毒素水平，进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）、序贯器官衰竭评分（SOFA）、简化急性生理学评分Ⅱ（SAPSⅡ）评分，计算胰岛素抵抗指数；并以20例健康志愿者及21例全身炎症反应综合征（SIRS）患者作为对照。结果脓毒症患者人ICU2h血浆总APN（mg／L）及HAP（mg／L）水平较健康对照组和SIRS组显著下降[总APN：2．87（2．28，3．89）比6．48±1．53、3．72（2．67，4．59），HAP：2．64（2．07，3．75）比5．12±1．98、3．33（2．23，4．24），P〈0．05或P〈0．01]，且与PCT水平呈显著负相关（r1=-0．559，r2=-0．530，均P〈0．01），与内毒素水平均无相关性；通过偏相关分析校正危重患者胰岛素抵抗对APN水平造成的影响后发现，APN与PCT及内毒素的相关性与未校正前基本相同。一般脓毒症、严重感染、感染性休克组间APN差异存在统计学意义，且与APACHEⅡ、SOFA、SAPSⅡ评分呈显著负相关（总APNr值分别为-0．868、-0．766、-0．725，HAPr值分别为-0．859、-0．715、-0．692，均P〈0．01）；脓毒症存活患者（41例）血浆总APN和HAP水平随疾病治愈逐渐升高（x21=34．520，x22=27．802，均P〈0．01），死亡患者（7例）总APN、HAP水平则呈下降趋势（x21=3．938，X22=3．938，均P〉0．05）；人ICU2h总APN、HAP与ICU住院时间（n=-0．275，P1=0．014；r2=-0．299，P2=0．007）、机械通气时间（r1=-0．393，r2=-0．519，均P〈0．01）呈显著负相关。结论血浆总APN及HAP在脓毒症患者中明显�] Objective To explore the regularity of changes in total adiponectin （APN） and high molecular bodyweight adiponectin （HAP） in sepsis, and its correlation with infection and its role on predicting prognosis. Methods A prospective study was conducted. Eighty patients with sepsis in intensive care unit （ICU） of Shengjing Hospital of China Medicine University from June to November in 2011 were enrolled in this study. The plasma APN （both total APN and HAP）, procalcitonin （PCT）, and endotoxin were determined with enzyme linked immunosorbent assay （ELISA） at 2 hours, 2 days, and 6 days after ICU admission. The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）, sequential organ failure assessment （SOFA）, and simplified acute physiology score Ⅱ （SAPS Ⅱ ） scores were recorded, and insulin resistance index was calculated. Twenty healthy volunteers and 21 patients with systemic inflammation response syndrome （SIRS） were enrolled as controls and SIRS group. Results Plasma total APN （rag/L） and HAP （rag/L） in sepsis patients at 2 hours after ICU admission were significantly decreased compared with control group and SIRS group [total APN： 2.87 （2.28, 3.89） vs. 6.48 ± 1.53, 3.72 （2.67, 4.59）; HAP： 2.64 （2.07, 3.75） vs. 5.12 ± 1.98, 3.33 （2.23, 4.24）, P〈0.05 or P〈0.01 ]. A negative correlation was found between total APN and HAP in plasma and PCT （r1 =-0.559, r2=-0.530, both P〈0.01）, but no correlation with endotoxin. Those correlations remained significantly in partial correlation analysis controlled by insulin resistance status. There were significauces in APN among sepsis, severe sepsis and septic shock groups, and negative correlations were found between APN and APACHE]I, SOFA, and SAPS]I scores （total APN rvalue, -0.868,-0.766,-0.725; HAP r value, -0.859, -0.715, -0.692, all P〈0.01 ）. Total APN and HAP in plasma of survivors with sepsis （n=41） was gradually increased following the recovery of the disease （X21 = 34

关 键 词：脂联素 高分子脂联素 脓毒症 预后 

分 类 号：R459.7[医药卫生—急诊医学]