创伤后多脏器功能衰竭患者白细胞流变性和细胞粘附分子水平的变化  

Changes of leukocyte rheologic charactetistics and cell adhesion molecules in patients with multiple organ failure after severe trauma

作　　者：曲彦[1] 刘成玉[2] 潘胜奇 张长禄 毕俏杰 

机构地区：[1]青岛市立医院ICU,266011 [2]青岛大学医学院诊断学教研室

出　　处：《中华外科杂志》2000年第10期778-780,共3页Chinese Journal of Surgery

摘　　要：目的　探讨创伤后多器官功能衰竭 (MOF)患者白细胞流变性和细胞粘附分子 (CAMs)水平的变化。　方法　采用DXC 30 0A型核孔膜红细胞变形能力测定仪、JYJ Ⅲ型体外血栓血小板粘附两用仪、酶联免疫吸附法 (ELISA) ,分别检测了 36例创伤后MOF患者、31例创伤患者和 35例健康人外周血液白细胞变形能力 (LD)、白细胞粘附功能 (LAF)、白细胞CD18表达、血浆可溶性细胞间粘附分子 1(sICAM 1)和可溶性血管细胞间粘附分子 1(sVCAM 1)的变化。　结果　MOF患者白细胞滤过指数 (LFI)、白细胞粘附率 (LAR)、白细胞CD18表达、sICAM 1,sVCAM 1均明显增高 ,与对照组和创伤组比较差异有极显著性 (F =6 8 45～ 116 2 0 ,q =12 16 1～ 2 1 374,P <0 0 0 1) ,MOF组死亡者各指标变化较存活者更明显 (t=6 92 0～ 11 6 6 5 ,P <0 0 0 1)。MOF患者LFI和LAR与sICAM 1,sVCAM 1和白细胞CD18表达呈正相关 (r=0 6 91～ 0 844 ,P <0 0 0 1) ,LFI与LAR呈正相关 (r =0 771,P <0 0 0 1)。　结论　白细胞流变性和CAMs水平异常参与了MOF的发生 。Objective To explore the changes of leukocyte rheologic characteristics and of cell adhesion molecule in patients with multiple organ failure(MOF) after severe trauma. Methods By using the erythrocyte deformability apparatus,platelet and thrombus adhesion dual purpose apparatus and enzyme linked immunosorbent assay(ELISA),We measured the leukocyte deformability(LD),leukocyte adhesion function(LAF),leukocyte CD18 expression,soluble intercellular adhesion molecule 1(sICAM 1) and soluble vascular cell adhesion molecule(sVCAM 1)concentration in 36 MOF patients ,31 trauma patients, and 35 to be controls. ResultsThe leukocyte filtration index(LFI),leukocyte adhesion rate(LAR),leukocyte CD18 expression, and sICAM 1 and sVCAM 1 concentration were significantly higher in MOF patients than in controls and trauma patients( F =68 45 116 20, q =12 161 21 374, P <0 00) , and the changes of these indicotors in MOF deaths were more obvious than those in MOF survivors ( t =6 920 11 665, P <0 00). The LFI and LAR in MOF patients were positively related to leukocyte CD18 expression, sICAM 1, and sVCAM 1 concentration( r =0 691 0 844, P <0 001); LFI was positively related to LAR( r =0 711, P <0 001). Conclusion The abnormalities of leukocyte rheologic characteristics and CAMs might be closely related to the occurrance of MOF and the severeness of pathologic changes.

关 键 词：多器官功能衰竭 创伤 白细胞流变性 CAMS 

分 类 号：R64[医药卫生—外科学]