1-磷酸鞘氨醇在脓毒性休克患者表达及其与预后关系的研究  

Expression of sphingosine 1-phosphate in patients with septic shock and its relationship with prognosis

作　　者：朱先华 胡晓飞[2] ZHU Xian-hua;HU Xiao-fei(Department of Critical Care Medicine, the First People＇s Hospital of Linhai, Linhai 317000, China;Department of Neurology, Taizhou Hospital in Zhejiang Province, Taizhou 317000, China)

机构地区：[1]浙江省临海市第一人民医院重症医学科,浙江临海317000 [2]浙江省台州医院神经内科,浙江台州317000

出　　处：《实用药物与临床》2018年第4期411-415,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的分析1-磷酸鞘氨醇(Sphingosine-1-phosphate,S1P)在脓毒性休克患者表达及其与预后的关系。方法选择136例脓毒症患者作为研究对象,分为单纯脓毒症、重度脓毒症和脓毒性休克3个亚组;比较各组血清S1P、降钙素原(Procalcitonin,PCT)表达水平、急性生理和慢性健康状况评分Ⅱ(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)、死亡率;根据脓毒性休克患者的APACHEⅡ,分为<15分、15~20分、>20分3个分段,比较不同分段的血清S1P、PCT表达水平、死亡率;根据脓毒性休克患者的预后情况,分为死亡组和存活组,比较两组患者的血清S1P、PCT表达水平、APACHEⅡ评分;采用Spearman相关分析脓毒性休克患者血清S1P表达水平与PCT、APACHEⅡ评分、死亡率的相关性。结果脓毒性休克组血清S1P、PCT表达水平、APACHEⅡ评分、死亡率均高于单纯脓毒症组、重度脓毒症组(P<0.05);而单纯脓毒症组与重度脓毒症组的血清S1P、PCT表达水平、APACHEⅡ评分、死亡率比较差异无统计学意义(P>0.05);APACHEⅡ<15分、15~20分、>20分脓毒性休克患者的血清S1P、PCT表达水平、死亡率比较差异有统计学意义(P<0.05);脓毒性休克患者血清S1P、PCT表达水平、死亡率随着APACHEⅡ评分提高而提高,各APACHEⅡ分段间差异有统计学意义(P<0.05);死亡组血清S1P、PCT表达水平、APACHEⅡ评分均高于存活组(P<0.05);经Spearman相关分析,脓毒性休克患者血清S1P与PCT表达水平、APACHEⅡ评分、死亡率均呈明显正相关(r=0.381、0.358、0.463,P<0.01)。结论 S1P在脓毒性休克患者血清中表达水平显著提高,且与患者预后呈负相关,通过监测血清S1P表达水平,可评估病情严重程度和预后。Objective To analyze the expression of sphingosine-l-phosphate （SIP） in patients with septic shock and its relationship with the prognosis. Methods Totally 136 patients with sepsis were divided into 3 groups： sepsis group,severe sepsis group and septic shock group. The levels of SIP and procalcitonin （PCT） in serum, acute physiology and chronic health assessment Ⅱ （APACHE Ⅱ ） score and mortality rate were compared. Septic shock pa- tients were divided into 3 subgroups according to the APACHE Ⅱ score （ 〈 15 points, 15 -20 points and 〉 20 points） , and the levels of SIP and PCT and APACHE Ⅱ score were compared among the subgroups. The septic shock group was further divided into death group and survival group according to their prognosis,and expression of SIP and PCT and A- PACHE Ⅱ score were compared between the two groups. The relationship of SIP expression in serum with PCT, A- PACHE Ⅱ score and mortality in patients with septic shock was analyzed by Spearman analysis. Results The levels of SIP and PCT expression,APACHE Ⅱ score and mortality in septic shock group were higher than those of sepsis group and severe sepsis group （P 〈 0. 05 ） , but no significant difference was found between sepsis group and severe sepsis group （P 〉0. 05）. There were significant differences in serum expression levels of SIP and PCT,APACHE Ⅱ score and the mortality among the different APACHE Ⅱ score subgroups （P 〈 0. 05 ）. The expression levels of SIP and PCTand mortality in patients with septic shock were raised along with the increased APACHE Ⅱ scores （ P 〈 0. 05 ）. The ex- pression level of serum SIP and PCT and APACHE Ⅱ score were higher the death group than in survival group （P 〈 0. 05 ）. Spearman correlation analysis showed there was a significant positive correlation between serum SIP in patients with septic shock and PCT expression level,APACHE Ⅱ score and mortality respectively （r -0. 381,0. 358 and 0. 463 ; P 〈 0. 01 ）. Conclusion The expression

关 键 词：脓毒性休克 1-磷酸鞘氨醇 降钙素原 APACHEⅡ评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]