维生素C联合乌司他丁对脓毒症伴ARDS患者血管内皮功能的保护作用研究  

Protective effect of vitamin C combined with ulinastatin on vascular endothelial function in patients with sepsis and ARDS

作　　者：陈城[1,2] 崔静[1,2] 纪小奇[1,2] 姚莉 CHEN Cheng;CUI Jing;JI Xiao-qi(Department of Critical Medicine,The Second People's Hospital of Hefei(Hefei Hospital Affiliated to Anhui Medical University),Hefei Anhui 230000,China;Department of Critical Medicine,The Second People's Hospital of Hefei Affiliated to Bengbu Medical College,Hefei Anhui 230000,China)

机构地区：[1]合肥市第二人民医院(安徽医科大学附属合肥医院)重症医学科,安徽合肥230000 [2]蚌埠医学院附属合肥市第二人民医院重症医学科,安徽合肥230000

出　　处：《临床和实验医学杂志》2023年第6期579-583,共5页Journal of Clinical and Experimental Medicine

基　　金：安徽蚌埠医学院自然科学基金重点项目(编号:2020byzd293);安徽省公益性研究联动计划项目(编号:15011d04060)。

摘　　要：目的探究脓毒症伴急性呼吸窘迫综合征(ARDS)患者应用维生素C联合乌司他丁对患者血管内皮功能的保护作用。方法前瞻性选取2021年5月至2022年7月合肥市第二人民医院收治的80例脓毒症伴ARDS患者,按随机数字表法分成对照组与观察组,各40例。对照组给予常规治疗+糖皮质激素,观察组在对照组基础上加用维生素C+乌司他丁。对比两组患者治疗前、治疗后3 d的急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)评分、血清炎症因子[白细胞介素(IL)-8、肿瘤坏死因子α(TNF-α)、IL-10]、血管内皮功能[血管内皮生长因子(VEGF)]、多糖包被损伤标志物[多配体蛋白聚糖-1(SDC-1)]及多糖包被降解产物[透明质酸(HA)、硫酸乙酰肝素(HS)]各指标的水平差异。结果治疗后3 d,两组患者的APACHEⅡ、SOFA评分较治疗前均降低,观察组的APACHEⅡ、SOFA评分分别为(15.40±3.70)、(4.61±2.02)分,均低于对照组[(20.20±4.90)、(7.50±3.10)分],差异均有统计学意义(P<0.05)。治疗后3 d,两组患者的血清IL-8、TNF-α、VEGF、SDC-1及HA、HS水平较治疗前均明显降低,IL-10水平均明显上升,观察组IL-8、TNF-α、VEGF、SDC-1及HA、HS水平分别为(208.44±24.47)pg/mL、(25.02±5.59)μg/mL、(90.91±9.30)mg/mL、(433.23±31.50)ng/mL、(65.72±10.63)μg/L、(47.37±6.74)μg/L,均低于对照组[(260.37±25.15)pg/mL、(31.53±5.62)μg/mL、(108.74±13.41)mg/mL、(486.67±30.64)ng/mL、(71.24±11.41)μg/L、(51.26±7.52)μg/L],IL-10水平为(60.11±7.79)pg/mL,高于对照组[(43.72±8.61)pg/mL],差异均有统计学意义(P<0.05)。结论在脓毒症伴ARDS患者中,在常规治疗基础上联合应用维生素C和乌司他丁,能够显著降低炎症因子及多糖包被降解产物、血管内皮特异性分子的含量,从而达到保护血管内皮、改善炎症反应的目的。Objective To explore the protective effect of vitamin C combined with ulinastatin on vascular endothelial function in patients with sepsis and acute respiratory distress syndrome(ARDS).Methods Eighty patients with sepsis and ARDS admitted to The Second People's Hospital of Hefei from May 2021 to July 2022 were prospectively selected and divided into control group and observation group according to the random number table,with 40 cases in each group.The control group was given conventional treatment+glucocorticoid,and the observation group was given vitamin C+ulinastatin on the basis of control group.The levels of acute physiology and chronic health assessment systemⅡ(APACHEⅡ)scores,Sequential Organ Failure Assessment(SOFA)scores,serum inflammatory factors[interleukin(IL)-8,tumor necrosis factor alpha(TNF-α),IL-10],vascular endothelial function[vascular endothelial growth factor(VEGF)],markers of polysaccharide coated lesion[syndecan-1(SDC-1)]and polysaccharide coated degradation products[hyaluronic acid(HA),heparan sulfate(HS)]were compared between the two groups before and 3 days after treatment.Results APACHEⅡand SOFA scores in 2 groups 3 days after treatment were decreased compared with those before treatment,the APACHEⅡscores and SOFA scores in the observation group were(15.40±3.70),(4.61±2.02)pionts,which were lower than thsoe in the control group[(20.20±4.90)and(7.50±3.10)pionts],and the differences were statistically significant(P<0.05).The levels of serum IL-8,TNF-α,VEGF,SDC-1,HA and HS in two groups of patients 3 days after treatment were significantly lower than those before treatment,and the level of IL-10 was significantly higher than that before treatment,and the levels of IL-8,TNF-α,VEGF,SDC-1,HA and HS in the observation group were(208.44±24.47)pg/mL,(25.02±5.59)μg/mL,(90.91±9.30)mg/mL,(433.23±31.50)ng/mL,(65.72±10.63)μg/L,(47.37±6.74)μg/L,which were lower than those in the control group[(260.37±25.15)pg/mL,(31.53±5.62)μg/mL,(108.74±13.41)mg/mL,(486.67±30.64)ng/mL,(71.2

关 键 词：脓毒症 维生素C 炎症因子 多糖包被 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]