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目的观察重症脓毒症患者血清LBP及sCD14的变化规律,探讨尿胰蛋白酶抑制剂的作用及可能的作用机制。方法用酶联免疫吸附(ELISA)法测定40例重症脓毒症患者各时点的血清LBP和sCD14浓度。将其随机分为乌司他丁组(U组)与对照组(C组),在相同的常规治疗基础上,U组给予乌司他丁针剂20万U静脉注射,2次/d,持续5 d。C组则给予同等量的生理盐水作为安慰剂对照。在治疗前、治疗后第2,3,6天抽取右侧桡动脉血测定血清LBP及sCD14的浓度,观察其动态变化的规律,并统计两组患者28 d的病死率。结果重症脓毒症患者在诊断成立的第2天血清LBP及sCD14水平达高峰并随后回落,第6天LBP水平仍高于正常而sCD14水平则降至正常范围。死亡组血清sCD14水平较存活组有升高,在第6天差异才具有统计学意义。治疗前两组患者APACHEⅡ评分值相似(P>0.05),U组患者28 d的病死率为18.2%(4/22),C组为50.0% (9/18),差异具有统计学意义(P<0.05)。治疗5 d后,血清sCD14水平在U组有下降(P<0.05)。结论血清sCD14水平可以作为判断重症脓毒症患者预后的指标之一;尿胰蛋白酶抑制剂能够改善脓毒症患者的预后,降低病死率,可能与其改变脓毒症患者血清中sCD14的水平有关。
Objective To observe the changes of serum LBP and sCD14 in patients with severe sepsis and explore the role of urinary trypsin inhibitor and its possible mechanism. Methods Serum levels of LBP and sCD14 were measured by enzyme-linked immunosorbent assay (ELISA) in 40 patients with severe sepsis at different time points. They were randomly divided into ulinastatin group (group U) and control group (group C). On the basis of the same conventional treatment, group U was given 200,000 U of ulinastatin injection intravenously twice a day 5 d. Group C received the same amount of saline as a placebo control. Before treatment, on the 2nd, 3rd and sixth day after treatment, the right radial artery blood was collected to determine the concentration of serum LBP and sCD14, and the dynamic changes of the two groups were observed. The 28-day mortality was also calculated. Results Serum levels of LBP and sCD14 peaked on the second day of diagnosis in patients with severe sepsis and then dropped back. On the 6th day, LBP levels were still above normal and sCD14 levels dropped to the normal range. The level of serum sCD14 in death group was higher than that in survival group, and the difference was statistically significant on the 6th day. The APACHEⅡscores of the two groups were similar before treatment (P> 0.05). The mortality of U group was 18.2% (4/22) on 28th day and 50.0% (9/18) on C group, the difference was statistically significant (P <0.05). After 5 days of treatment, serum sCD14 level decreased in U group (P <0.05). Conclusions Serum sCD14 level can be used as a marker to predict the prognosis of patients with severe sepsis. Urinary trypsin inhibitor can improve the prognosis and reduce the mortality of patients with sepsis, which may be related to the change of serum sCD14 in patients with sepsis.