血管性血友病因子裂解酶在脓毒性休克患者中低表达且对其预后有评估价值

申良红.血管性血友病因子裂解酶在脓毒性休克患者中低表达且对其预后有评估价值[J].内科急危重症杂志,2022,28(4):289-293

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DOI：10.11768/nkjwzzzz20220407

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作者	单位	E-mail
申良红	新疆维吾尔自治区人民医院	slh6@sina.com

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中文摘要:

目的：探讨血管性血友病因子裂解酶(ADAMTS13)在脓毒性休克患者中的表达意义。方法：选取脓毒症患者150例，按严重程度分为单纯脓毒症组(43例)、重度脓毒症组(48例)、脓毒性休克组(59例)。另外选取同期体检的健康志愿者60例作为健康对照组。检测脓毒症组患者确诊后第1、3、5、7天及健康对照组血浆ADAMTS13水平，并行急性生理与慢性健康状况评估(APACHEⅡ)评分，随访患者28d预后情况，分析上述指标对患者预后的预测价值。结果：脓毒症组不同时间点血浆ADAMTS13水平均低于健康对照组（P均＜0.05）。脓毒症3个亚组ADAMTS13、血管性血友病因子(vWF)、抗凝血酶(AT)、白细胞介素(IL)-6水平、APACHEⅡ评分比较，差异有统计学意义(P均＜0.05)。单纯脓毒症组ADAMTS13、AT高于重度脓毒症组和脓毒性休克组且重度脓毒症组高于脓毒性休克组(P均＜0.05)，vWF、IL-6水平、APACHEⅡ评分低于重度脓毒症组和脓毒性休克组，且重度脓毒症组低于脓毒性休克组(P均＜0.05)。单纯脓毒症组和重度脓毒症组患者均无死亡病例。脓毒性休克组中存活29例，死亡30例，死亡率为50.85%。脓毒性休克死亡患者血浆ADAMTS13、AT水平低于存活者，vWF、IL-6水平、APACHEⅡ评分高于存活者(P均＜0.05)。血浆ADAMTS13、vWF、AT、IL-6水平、APACHEⅡ评分为脓毒性休克患者预后的危险因素(P均＜0.05)。ADAMTS13、vWF、AT、IL-6水平、APACHEⅡ评分对脓毒性休克患者预后死亡的预测价值较高，其中以ADAMTS13预测价值最高 (P均＜0.05)。结论：脓毒性休克患者血浆ADAMTS13水平明显降低，降低程度与患者疾病严重程度及预后有关，可能与调控vWF、AT、IL-6水平表达，介导炎症、凝血障碍的发生相关。

英文摘要:

Objective: To explore the value of the ADAMTS13 expression in septic shock patients. Methods: 150 patients with sepsis were divided into 3 groups: mild sepsis group (43 cases), severe sepsis group (48 cases) and septic shock group (59 cases). A total of 60 healthy volunteers were selected as the control group. The ADAMTS13 activity in the peripheral blood of d1, d3, d5, d7 of sepsis patients enrolled into hospital and control group during physical examination were tested. The acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score was also recorded and compared within 4 groups. All patients were followed up for 28 days. Results: The ADAMTS13 activity [d1 (65.02±2.16)%, d3 (59.65±2.00)%, d5 (53.21±1.02)%, d7 (50.12±1.00)%] of all patients at different time points was lower than that of the control group [(80.49±5.45)%] (all P<0.05). There were statistically significant differences in ADAMTS13 activity among 3 groups of sepsis at different time points (all P< 0.05). The ADAMTS13 activity in the mild sepsis group was lower than the severe sepsis group and septic shock group (all P<0.05), and that in the severe sepsis group was lower than in the septic shock group (P<0.05). There were statistically significant differences in the ADAMTS13, von Willebrand factor (vWF), antithrombin (AT), interleukin-6 (IL-6) and APACHEⅡ scores among 3 groups of sepsis (all P<0.05). The ADAMTS13 and AT in the mild sepsis group were higher (all P<0.05), and the vWF, IL-6 and APACHEⅡ score were lower than those in the severe sepsis group and septic shock group (all P<0.05). The ADAMTS13 and AT in severe sepsis group were higher (all P<0.05), and vWF, IL-6 level and APACHEⅡ score were lower than in septic shock group (all P<0.05). There were no deaths in the mild sepsis group and severe sepsis group. In the septic shock group, 29 cases survived, 30 cases died, and the mortality rate was 50.85%. The ADAMTS13 activity and AT in patients who died from septic shock were lower than the survival patients in the septic shock group (all P<0.05). The vWF, IL-6 and APACHEⅡ score in patients who died from septic shock were higher than those in the survival patients in the septic shock group (all P<0.05). The ADAMTS13, vWF, AT, IL-6 and APACHE II scores were prognostic risk factors of patients with septic shock (all P<0.05). ADAMTS13, vWF, AT, IL-6 and APACHEⅡ scores had higher predictive value for the prognosis of death in patients with septic shock. Among them, ADAMTS13 had the highest predictive value (all P<0.05). Conclusion: Plasma ADAMTS13 in patients with septic shock is significantly reduced, which is related to the severity and prognosis. It may be related to the occurrence of inflammation and coagulopathy by regulating the expression of vWF, AT and IL-6.