内皮多糖蛋白包被在液体过负荷治疗中的意义  

Significance of endothelial glycocalyx in fluid overload therapy

作　　者：饶歆[1] 宋慧敏 王静[1] 王丹雯 杨丽洁 冯茂辉[2] 李建国[1] Rao Xin;Song Huimin;Wang Jing;Wang Danwen;Yang Lijie;Feng Maohui;Li Jianguo(Department of Intensive Care Unit, Zhongnan Hospital, Wuhan University, Wuhan 430071, China;Dpartment of Gastrointestinal Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China)

机构地区：[1]武汉大学中南医院重症医学科,430071 [2]武汉大学中南医院胃肠外科,430071

出　　处：《中华实验外科杂志》2019年第4期755-758,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金(81770283);武汉市腹膜癌临床医学研究中心资助项目(2015060911020462).

摘　　要：目的观察内皮多糖蛋白包被在液体过负荷治疗中的变化,探讨其变化产生的意义。方法57例液体过负荷的患者被纳入,入组后在0、12、24、48、72 h留取血、尿液,酶联免疫吸附试验(ELISA)检测清除液体负荷的过程中内皮多糖蛋白包被脱落成分,即透明质酸(HA)、黏结合蛋白多糖-1(Syn-1)、硫酸乙酰胺肝素(HS)、硫酸软骨素(CS)的变化。结果液体负荷过重的患者在达到液体清除目标后,血中Syn-1和HA水平较治疗前明显下降:(1.6±0.5)μg/ml比(4.6±0.8)μg/ml、(169.1±44.4)μg/ml比(369.8±79.2)μg/ml,P<0.05;HS、CS与治疗前比较差异无统计学意义[(436.9±106.2) pg/ml比(437.1±105.7) pg/ml、(7.8±4.2)μg/ml比(8.3±5.3)μg/ml,P>0.05]。在48 h达到清除目标的患者,容量清除最多,并且HA、Syn-1下降最明显,与其他时间比较P<0.05。胸心外科术后患者比非胸心外科术后患者血浆HA浓度明显下降[(3.0±1.0)μg/ml比(2.1±0.3)μg/ml,P<0.01;连续性肾替代治疗(CRRT)和NCRRT两组之间无论血浆、尿液还是CRRT废液差异均无统计学意义(P>0.05)。结论液体过负荷可使血浆中内皮多糖蛋白包被成分增加,液体清除后可降低血浆中内皮多糖蛋白包被成分,改善微循环。Objective To observe the changes and significance of endothelial glycocalyx during fluid overload therapy. Methods Fifty-seven patients with fluid overload were enrolled. Arterial blood and urine were collected at 0, 12, 24, 48 and 72 h after enrollment. Enzyme linked immunosorbent assay (ELISA) was used to detect the components of glycocayx, namely hyaluronic acid (HA), Syndecance-1 (Syn-1), acetamide heparin sulfate (HS), and chondroitin sulfate (CS). Results The primary outcome turned out that as compared with the baseline, the levels of HA and Syn-1 were respectively (1.6±0.5)vs.(4.6±0.8)μg/ml,(169.1±44.4)vs.(369.8±79.2)μg/ml, P<0.05, while the levels of HS and CS were respectively (436.9±106.2) vs.(437.1±105.7) pg/ml,(7.8±4.2)vs.(8.3±5.3)μg/ml, P>0.05. In the group of 48 h, the clearance capacity was the largest, and the decrease of HA and Syn-1 was the most significant, P<0.05. The plasma concentrations of HA in the non-thoracic surgery subgroup and the thoracic surgery subgroup were [(3.0±1.0)μg/ml and (2.1±0.3)μg/ml respectively, P<0.01]. No significant change was observed either in the four components of urine or in the plasma, urine and liquid waste specimens of continuous renal replacement terapy (CRRT) between CRRT and NCRRT groups (P>0.05). Conclusion Fluid overload can increase the levels of endothelial glycocalyx, and excessive liquid clearance can decrease the levels of endothelial glycocalyx and improve the microcirculation.

关 键 词：内皮多糖蛋白包被 液体过负荷 微循环 

分 类 号：R459.7[医药卫生—急诊医学]