【摘要】：目的:本研究為探討膿毒癥血小板減少癥患者血清中炎癥相關(guān)細(xì)胞因子的表達(dá)差異,進(jìn)而明確膿毒癥血小板減少患者的炎癥反應(yīng)機制及血小板減少在膿毒癥患者預(yù)后中的影響。內(nèi)容:收集于2015年3月至2015年11月入住天津市第一中心醫(yī)院重癥監(jiān)護(hù)病房(ICU)的膿毒癥血小板減少患者10例,膿毒癥不伴隨血小板減少的患者7例,以及健康志愿者7例。以上收集的24例血清樣本為研究對象,應(yīng)用抗體芯片檢測技術(shù)測定研究對象中34種炎癥相關(guān)細(xì)胞因子的表達(dá)情況,同時觀察記錄上述17例膿毒癥患者的預(yù)后。結(jié)果:抗體芯片技術(shù)檢測血清樣本中炎癥相關(guān)細(xì)胞因子結(jié)果顯示:膿毒癥不伴血小板減少組較健康對照組細(xì)胞因子變化:促炎細(xì)胞因子:CD40L、CD40、IL-17A、IL-22、IL-6、MIP-3alpha、表達(dá)上調(diào)(fold change1.5),IL-17F、IL-21、IL-6R表達(dá)下調(diào)(fold change0.67)。抗炎細(xì)胞因子:GM-CSF表達(dá)上調(diào)(fold change1.5),IL-10表達(dá)下調(diào)(fold change0.67)。膿毒癥血小板減少組較健康對照組患者,促炎細(xì)胞因子:CD30、CD40L、CD40、GITR、IL-1s RⅠ、IL-1s RⅡ、IL-17F、IL-17R、IL-1β、IL-21、IL-21R、IL-22、IL-23p19、IL-28A、IL-6、MIP-3α表達(dá)上調(diào)(fold change1.5),抗炎細(xì)胞因子:IL-12p40、IL-12p70、TGF-β1、TGF-β3、TRANCE表達(dá)上調(diào)(fold change1.5),IL-10表達(dá)下調(diào)(fold change0.67)。膿毒癥血小板減少組與膿毒癥不伴血小板減少組相比較,促炎細(xì)胞因子CD30、CD40L、CD40、GITR、IL-1s RⅠ、IL-1s RⅡ、IL-17F、IL-17R、IL-1β、IL-21、IL-21R、IL-23p19、IL-28A、IL-6、IL-6s R、MIP-3alpha表達(dá)上調(diào)(fold change1.5)�？寡准�(xì)胞因子:TGF-β1、TGF-β3、IL-12p40、IL-12p70、TRANCE表達(dá)上調(diào)(fold change1.5),IL-13、IL-10、GM-CSF表達(dá)下調(diào)(fold change0.67)。膿毒癥血小板減少患者較膿毒癥不伴血小板減少患者及健康對照者血清中大部分促炎細(xì)胞因子表達(dá)上調(diào),只有少部分促炎細(xì)胞因子表達(dá)下調(diào),膿毒癥患者發(fā)生血小板減少提示促炎反應(yīng)加劇,膿毒癥伴血小板減少患者抗炎細(xì)胞因子表達(dá)紊亂。通過觀察記錄各組膿毒癥患者的預(yù)后顯示:膿毒癥血小板減少組死亡率為50%,膿毒癥不伴血小板減少組死亡率為28.6%。膿毒癥伴血小板減少患者死亡率較膿毒癥不伴血小板減少患者死亡率較高。結(jié)論:膿毒癥促炎及抗炎免疫失調(diào),以促炎反應(yīng)為主,膿毒癥伴血小板減少促炎反應(yīng)進(jìn)一步加劇,抗炎反應(yīng)屬免疫抑制狀態(tài)。血小板活化參與膿毒癥的發(fā)病,膿毒癥伴血小板減少血小板活化進(jìn)一步增加。膿毒癥伴血小板減少死亡風(fēng)險增高。
[Abstract]:Objective: to investigate the expression of inflammatory cytokines in serum of patients with sepsis thrombocytopenia, and to clarify the mechanism of inflammatory response and the influence of thrombocytopenia on the prognosis of patients with sepsis. Contents: ten patients with sepsis, 7 patients with sepsis without thrombocytopenia and 7 healthy volunteers who were admitted to (ICU) of Tianjin first Central Hospital from March 2015 to November 2015 were collected. 24 serum samples collected above were used to detect the expression of 34 inflammatory cytokines and the prognosis of 17 patients with sepsis were observed. Results: the results of detection of inflammatory cytokines in serum samples by antibody chip technique showed that the cytokines in sepsis without thrombocytopenia group were higher than those in healthy control group. The cytokines of proinflammatory cytokines: 1 / CD40L / CD40 / IL-17A ~ + IL-22 / IL-6MIP-3alpha were up-regulated (fold change1.5) / IL-17FU / IL-21 / IL-6R expression (fold change0.67). Anti-inflammatory cytokine: GM-CSF up-regulated (fold change1.5) down-regulated IL-10 expression (fold change0.67). In sepsis thrombocytopenia group, the inflammatory cytokines CD40L-, CD40TITR+, IL-1s R 鈪，

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