那屈肝素钙联合rhAPC对脓毒症患儿TLR3和sE-选择素的影响  

Effect of nadropar calcium combined with rhAPC on TLR3 and sE-selectin in children with sepsis

作　　者：刘红伟[1] 安冀坤 陈丽[2] 刘燕[3] 刘艳静 LIU Hongwei;AN Jikun;CHEN Li;LIU Yan;LIU Yanjing(Department of Pediatrics,General Hospital of North China Petroleum Administration Bureau,Cangzhou,Hebei 062552,China;Department of Dermatology,General Hospital of North China Petroleum Administration Bureau,Cangzhou,Hebei 062552,China;Department of Nutrition,General Hospital of North China Petroleum Administration Bureau,Cangzhou,Hebei 062552,China;Department of Nursing,General Hospital of North China Petroleum Administration Bureau,Cangzhou,Hebei 062552,China)

机构地区：[1]华北石油管理局总医院儿科,河北沧州062552 [2]华北石油管理局总医院皮肤科,河北沧州062552 [3]华北石油管理局总医院营养科,河北沧州062552 [4]华北石油管理局总医院护理部,河北沧州062552

出　　处：《国际检验医学杂志》2020年第23期2893-2897,共5页International Journal of Laboratory Medicine

摘　　要：目的研究那屈肝素钙联合重组人活化蛋白C(rhAPC)对脓毒症患儿Toll样受体3(TLR3)、可溶性E选择素(sE-选择素)的影响。方法收集2016年6月至2019年12月期间该院收治的200例脓毒症患儿,根据随机数字表法分为对照组和观察组A、B、C,每组各50例。对照组采用常规对症治疗,观察组A、B、C在常规治疗的基础上分别采用静脉注射rhAPC、皮下注射那屈肝素钙及二者联用。观察4组患儿临床疗效、不良反应情况,测定治疗前后外周血自然杀伤细胞表达率、TLR3、sE-选择素、血凝功能指标及小儿危重病例评分(PCIS),并进行统计学分析。结果观察组C治疗有效率高于观察组A、B组和对照组(P<0.05),观察组C病死率低于对照组(P<0.05)。4组患儿治疗后动脉血氧分压、血氧饱和度、CD3+、CD4+水平增加,动脉血二氧化碳分压及CD8+水平降低,其中观察组C改善效果最佳(P<0.05)。4组患儿治疗后血小板计数、纤维蛋白原增加,凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、D-二聚体降低,观察组C改善最佳(P<0.05)。治疗后观察组C的TLR3、sE-选择素水平低于A、B组和对照组,PCIS高于A、B组和对照组(P<0.05)。观察组C组住院时间短于观察组A、B组和对照组(P<0.05)。4组患儿不良反应发生率差异无统计学意义(P>0.05)。结论那屈肝素钙联合rhAPC治疗儿童脓毒症效果显著,可有效改善凝血功能,调控免疫应答,从而降低TLR3、sE-选择素水平,提高治疗效果。Objective To study the effect of nadroparin calcium combined with recombinant human activated protein C(rhAPC)on Toll-like receptor 3(TLR3)and soluble E-selectin(sE-selectin)in children with sepsis.Methods A total of 200 children with sepsis admitted in the hospital from June 2016 to December 2019 were collected and randomly divided into control group and observation group A,B and C,with 50 cases in each group.The control group was treated with conventional symptomatic treatment,while the observation group A,B and C were given intravenous injection of rhAPC,subcutaneous injection of nadroparin calcium,and a combination of the two on the basis of conventional treatment.The clinical efficacy and adverse reactions of the 4 groups of children were observed,and the expression rate of peripheral blood NK cells,TLR3,sE-selectin,blood coagulation function indexes and the pediatric critical illness score(PCIS)before and after treatment were measured and analyzed statistically.Results The effective rate of treatment in observation group C was higher than that in observation group A,B and control group(P<0.05),and the mortality of observation group C was lower than that in control group(P<0.05).After treatment,the levels of the arterial blood oxygen partial pressure,blood oxygen saturation,CD3+and CD4+were increased,the arterial blood carbon dioxide partial pressure and CD8+levels were decreased in the 4 groups,and the improvement effect of observation group C was the best(P<0.05).After treatment,platelet count,fibrinogen increased,prothrombin time,activated partial thromboplastin time,thrombin time,D-Dimer were decreased in the 4 groups,and the improvement of observation group C was the best(P<0.05).After treatment,the levels of TLR3 and sE-selectin in observation group C were lower than those in group A,B and control group,and PCIS was higher than that in group A,B and control group(P<0.05).The length of hospital stay in observation group C was shorter than that in observation group A,B and control group(P<0.05).There was

关 键 词：那屈肝素钙 重组人活化蛋白C 脓毒症 TOLL样受体3 SE-选择素 

分 类 号：R459.7[医药卫生—急诊医学]