本文選題：重癥感染 + P-選擇素　； 參考：《鄭州大學(xué)》2013年碩士論文

【摘要】：背景 重癥感染是由于病原微生物在機(jī)體內(nèi)繁殖,引起某一臟器或全身性感染,且致該器官或全身多臟器功能損害為特征的臨床綜合癥。盡管抗感染藥物、多器官支持和液體復(fù)蘇等綜合治療有了長足進(jìn)步,但在ICU病房,重癥感染仍是導(dǎo)致患者死亡的重要因素,其發(fā)病率在世界范圍內(nèi)呈逐年士升趨勢。在美國,嚴(yán)重感染在致死原因中居第10位,每小時約有25人因重癥感染死亡。我國一項多中心研究證明重癥感染發(fā)生率與國外相似,約為8.68%。由于重癥感染患者缺乏特異性的臨床癥狀及體征,探索判斷重癥感染患者病情變化及評估預(yù)后的輔助檢查顯得尤為重要。研究證明,重癥感染患者多伴有血小板計數(shù)的變化,缺氧、病原微生物及其毒物作為始動因子,可引起機(jī)體的微血管內(nèi)皮損傷,炎癥介質(zhì)的釋放引起血小板形態(tài)的改變、血小板聚集及血小板成分的釋放,即血小板活化,這一活化過程導(dǎo)致血液粘滯度異常及微血栓的形成,使病情發(fā)作展迅速,最終導(dǎo)致多臟器功能障礙甚至多臟器功能衰竭。血小板及其活化產(chǎn)物廣泛參與了炎癥反應(yīng)并在炎癥進(jìn)展中發(fā)揮重要作用,并在分子水平與凝血反應(yīng)鏈之間存在錯綜復(fù)雜的聯(lián)系。基于P-選擇素作為血小板活化的“金標(biāo)準(zhǔn)”,本研究通過監(jiān)測重癥感染患者血漿P-選擇素、血小板計數(shù),來幫助判斷重癥感染患者病情變化及評估其預(yù)后。 目的 探討血漿P-選擇素、血小板計數(shù)能否作為判斷重癥感染患者病情變化及評估其預(yù)后的指標(biāo),為重癥感染患者病情變化和感染控制提供重要的理論依據(jù)和方法。 方法 收集2011年9月至2013年2月鄭州大學(xué)第一附屬醫(yī)院呼吸ICU病房重癥感染患者80例作為感染組,其中男43例,女37例,年齡26至86歲,平均年齡56.0±3.8歲。選擇同期健康體檢者40例,作為對照組,其中男性20例,女性20例,年齡在20至86歲,平均年齡57.0±2.8歲,兩組性別、年齡差別均無統(tǒng)計學(xué)意義(P0.05)。感染組在入住我科24小時內(nèi)及第7天(對照組在體檢當(dāng)日)空腹?fàn)顟B(tài)下抽外周靜脈血,分別采用雙抗體夾心酶聯(lián)免疫測定法(ELISA法)和全自動五分類血液細(xì)胞分析檢測血漿P-選擇素水平、血小板計數(shù),比較兩組間的血漿P-選擇素水平、血小板計數(shù)有無差異,并分析感染組血漿P-選擇素水平與血小板計數(shù)有無相關(guān)性；感染組根據(jù)入住我科2周內(nèi)觀察患者病情,根據(jù)不同轉(zhuǎn)歸,分為好轉(zhuǎn)組和惡化組,比較兩組患者在入住我科第7天的血漿P-選擇素水平、血小板計數(shù)有無差異。 結(jié)果 1.感染組與對照組比較,血漿P-選擇素水平(μg/L)明顯升高(27.60+3.24比9.41±4.63,P=0.03),差異有統(tǒng)學(xué)意義血小板計數(shù)(x109/L)無明顯下降(198±61比236±73,P=0.58),差異無統(tǒng)學(xué)意義。 2.好轉(zhuǎn)組與惡化組比較,入科第7天血漿P-選擇素明顯升高(32.24±2.87比19.62±3.48,P=0.005)、血小板計數(shù)明顯下降(48±37比201±73,P=0.01),差異有統(tǒng)計學(xué)意義。 3.感染組入科24小時內(nèi)和第7天血漿P-選擇素水平與血小板計數(shù)均呈負(fù)相關(guān)(24小時內(nèi)：r=-0.68,P=0.02；入科第7天：r=-0.88,P=0.001)。 結(jié)論 1.重癥感染患者存在血小板活化,其釋放的粘附分子之一P-選擇素可以作為判斷重癥感染患者病情變化的指標(biāo)。 2.血漿P-選擇素水平與血小板計數(shù)呈負(fù)相關(guān),血漿P-選擇素水平升高且血小板計數(shù)進(jìn)行性下降預(yù)示著重癥感染患者病情嚴(yán)重,預(yù)后差。
[Abstract]:background
Severe infection is a clinical syndrome caused by the pathogenic microorganism breeding in the body, causing a certain organ or systemic infection and causing the function damage of the organ or multiple organs. Despite the anti infective drugs, multiple organ support and fluid resuscitation, the comprehensive treatment has made great progress, but in the ICU ward, the severe infection is still the cause of the patient. An important factor in death, its incidence is rising year by year in the world. In the United States, serious infection is the tenth leading cause of death, and about 25 people die per hour because of severe infection. A multicenter study in China has proved that the incidence of severe infection is similar to that of foreign countries, which is about 8.68%. due to the lack of specificity in patients with severe infection. It is very important to explore the symptoms and signs. It is very important to explore the changes of the patient's condition and evaluate the prognosis of the patients with severe infection. It has been proved that the patients with severe infection are often accompanied by changes in platelet count, hypoxia, pathogenic microbes and their toxicants as a starting factor, which can cause the microvascular endothelial injury of the body and the release of the inflammatory mediators to cause the small blood. Changes in the form of platelets, platelet aggregation and release of platelet components, that is, platelet activation. This activation process leads to abnormal blood viscosity and the formation of micro thrombus, which causes rapid development of the disease and eventually leads to multiple organ dysfunction or even multiple organ failure. There is an important role in the progression of the disease, and there is a complex link between the molecular level and the coagulation reaction chain. Based on P- selectin as the "gold standard" for platelet activation, this study helps to determine the condition of severe infection patients and evaluate their prognosis by monitoring the plasma P- selectin and platelet counts in critically infected patients.
objective
To investigate whether the plasma P- selectin and the platelet count can be used as an indicator to judge the change of the patient's condition and evaluate the prognosis of the severe infection, and provide an important theoretical basis and method for the change of the patient's condition and the control of the infection.
Method
From September 2011 to February 2013, 80 cases of severe infection in the respiratory ICU ward of the First Affiliated Hospital of Zhengzhou University were collected as infection group, including 43 males and 37 females, aged from 26 to 86 years old, with an average age of 56 + 3.8 years. We selected 40 cases of healthy physical examination in the same period as the control group, including 20 men, 20 women, 20 to 86 years, average age 57 + 2. .8 years old, two groups of sex, age difference was not statistically significant (P0.05). Infection group in 24 hours in our department and the 7 day (the control group on the day of physical examination) out of the abdominal peripheral venous blood, the use of double antibody sandwich enzyme-linked immunoassay (ELISA) and the full automatic five classification of blood cell analysis of plasma P- selectin level, blood is small The level of plasma P- selectin was compared between the two groups. There was no difference in the platelet count, and there was no correlation between the plasma P- selectin level and the platelet count in the infection group. The infection group was divided into the improvement group and the worsening group according to the different outcome, and the two groups were compared to the 7 day of my section. There was no difference in plasma P- selectin level and platelet count.
Result
Compared with the control group, the level of plasma P- selectin (27.60+3.24) was significantly higher (27.60+3.24 than 9.41 + 4.63, P=0.03). There was no significant difference in platelet count (x109/L) (198 + 61, 236 + 73, P=0.58), and the difference was not significant.
2. compared with the deteriorating group, the plasma P- selectin was significantly increased (32.24 + 2.87 to 19.62 + 3.48, P=0.005), and the platelet count decreased significantly (48 + 37 compared to 201 + 73, P=0.01), and the difference was statistically significant.
The plasma P- selectin level was negatively correlated with the platelet count within 24 hours and seventh days in the 3. infection group (24 hours: r=-0.68, P=0.02, and the 7 day of entry: r=-0.88, P=0.001).
conclusion
1. platelet activation exists in critically ill patients. P- selectin, one of the adhesion molecules released, can be used as an indicator of the severity of severe infection.
2. the level of plasma P- selectin is negatively correlated with the platelet count, the level of plasma P- selectin and the progressive decrease of platelet count indicate that the patients with severe infection are seriously ill and the prognosis is poor.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R459.7

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