抗凝治疗对脓毒症凝血和炎症指标的影响及其意义  

The effect of anticoagulant therapy on coagulation and inflammation markers in sepsis patients and its significance

作　　者：韩宇[1] 高传玉[2] 秦秉玉[3] 徐红党[2] 宋先荣[4] 李斌[1] 彭帮田[1] 范太兵[1] 程兆云[4] 

机构地区：[1]郑州大学人民医院儿童心脏中心,河南郑州450003 [2]郑州大学人民医院心内科,河南郑州450003 [3]郑州大学人民医院中心ICU,河南郑州450003 [4]郑州大学人民医院心外科,河南郑州450003

出　　处：《中华危重病急救医学》2015年第2期102-105,共4页Chinese Critical Care Medicine

基　　金：基金项目：河南省科技发展计划项目（132102310190）;国家l临床重点专科建设项目（2011年）

摘　　要：目的 探讨低分子肝素抗凝治疗对脓毒症患者凝血功能和炎症反应的影响。方法 本研究为前瞻性随机对照临床试验（RCT）。将2012年3月至2014年5月郑州大学人民医院重症加强治疗病房（ICU）收治的60例脓毒症患者按照随机数字表法分为对照组和观察组，每组30例。以脓毒症确诊为始点，观察7d为终点。所有患者参照2008年国际脓毒症治疗指南及其他治疗策略进行治疗，观察组于入ICU当日即应用低分子肝素钙0．6mL皮下注射，每日2次，连续7d10各组于治疗1、3、5、7d清晨空腹取外周静脉血，采用酶联免疫吸附试验（ELISA）检测CD62p、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α），免疫比浊法测定D-二聚体，同时计算当日急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，并统计多器官功能障碍综合征（MODS）发生率。结果 两组患者治疗1d时血中CD62p、D-二聚体、IL-6、TNF-dα和APACHEⅡ评分比较差异均无统计学意义。观察组治疗后各指标均逐渐下降，治疗3d时CD62p及治疗5d时D-二聚体、IL-6、TNF-α、APACHEⅡ评分即明显低于治疗1d时；而对照组各指标呈先降后升趋势，治疗5d时D-二聚体、IL-6、TNF-α水平已明显高于1d时。与对照组同时间点比较，观察组治疗7d时CD62p、D-二聚体、IL-6、TNF-α及APACHEⅡ评分均明显降低[CD62p（μL）：22．64±2．88比31．52±2．81，D-二聚体（g/L）：1．32±0．46比4．79±0．82，IL-6（ng/L）：5．84±1．87比49．64±3．12，TNF-α（ng/L）：21．04±3．15比130．58±6．26，APACHEⅡ评分（分）：9．71±2．02比14．17±2．38，均P〈0．05]。相关性分析显示，观察组CD62p、D-二聚体、IL-6、TNF-α与APACHEⅡ评分均呈显著正相关（r值分别为0．907、0．868、0．880、0．693，均P=0．000）。观察组MODS发生率明显低于对照组[26．7％（8／30）比46．7％（14/30），x^2=3．943，P=0．0Objective To study the effect of anticoagulant therapy with low molecular weight heparin （LMWH） on coagulation and inflammation markers in sepsis patients. Methods A prospective randomized controlled trial was conducted. Sixty sepsis patients admitted to intensive care unit （ICU） of Zhengzhou University People＇s Hospital from March 2012 to May 2014 were divided into control group and observation group, with 30 cases in each group. The observations were begun as soon as the diagnosis of sepsis was established, and the observation time was 7 days. All sepsis patients were treated according to the 2008 international sepsis treatment guidelines. Every patient in the observation group was subcutaneously injected with LMWH 0.6 mL on the first day of ICU admission, twice a day for 7 days. The blood from peripheral vein was collected at 1, 3, 5, 7 days of treatment, and CD62p, interleukin-6 （IL-6）, and tumor necrosis factor-α （TNF-α ） were determined by enzyme linked immunosorbent assay （ELISA）, D-dimmer was determined by immunoturbidimetry, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score wasrecorded, and incidence of multiple organ dysfunction syndrome （MODS） was also evaluated. Results There were no significant differences in values of all parameters, including CD62p, D-dimmer, IL-6, TNF- α, and APACHE Ⅱ score at 1 day of treatment. The values of all parameters in observation group were gradually decreased. CD62p at 3 days of treatment and D-dimmer, IL-6, TNF-α, and APACHE I1 score at 5 days of treatment were significantly lower than those at 1 day of treatment. The values in the control group were decreased at first and then increased, as D-dimmer, IL-6 and TNF- α were significantly higher on the 5th day than those at 1 day of treatment. Compared with control group, CD62p, D-dimmer, IL-6, TNF- α and APACHE II score on the 7th day of treatment were significantly lowered in observation group [CD62 （μg/L）： 22.64±2.88 vs. 31.52±2.81, D-dimmer （g/L）�

关 键 词：脓毒症 抗凝 P-选择素 D-二聚体 白细胞介素-6 肿瘤坏死因子-α 急性生理学与慢性健康状况评分系统Ⅱ评分 

分 类 号：R459.7[医药卫生—急诊医学]