脓毒症患者急性时相蛋白的动态联合检测
张庚 陈扬波 余丹凤 胡马洪【摘要】 目的： 研究血清急性时相蛋白水平在脓毒症和重度脓毒症患者炎症过程中的变化及其临床意义。方法：采用全自动特定蛋白定量分析方法，分组动态测定1、3、7、14和21 d 5个时间点29例脓毒症(SP)组和27例重度脓毒症(SSP)组患者的C反应蛋白(CRP)、a1-酸性糖蛋白(AAG)、铜蓝蛋白(CER)以及结合珠蛋白(HP)的血清含量，并与30例健康体检者进行对照分析。结果 ①SP组：CRP和AAG在炎症早期1 d内就显著升高(P<0.01和P<0.05),其中CRP 3 d达高峰,AAG 3~7 d达高峰，AAG持续高峰时间达14 d，CRP和AAG各时间点间差异显著(P均<0.01)；CER无显著升高(P>0.05)，各时间点差异不显著(P>0.05)；HP早期也显著升高(P<0.05)，但各时间点差异无显著性(P>0.05)。②SSP组：CRP和AAG均显著升高(P均<0.01)，高峰持续时间均长达14 d，各时间点间差异非常显著(P<0.01)；CER 7 d前呈下降趋势(P<0.05)，各时间点间差异有显著性(P<0.05);HP在14 d才显著升高，21 d达峰值(P均<0.05)，各时间点间差异有显著性(P<0.05)。组间趋势变化比较：CRP、AAG和HP差异均有显著性(P均<0.05)，CER差异无显著性(P>0.05)。结论： CRP早期升高是感染的敏感指标，CRP和AAG高峰持续时间延长提示重度感染；HP不升高或呈进行性下降也提示重度感染；CER对临床感染程度的判断缺乏敏感性。
【关键词】 急性时相蛋白； 脓毒症； 重度脓毒症
Clinical study of dynamic changes in acute phase proteins in sepsis
ZHANG Geng, CHEN Yang-bo, YU Dan-feng, HU Ma-hong.
ICU, Zhejiang Tongde Hospital, Hangzhou 310012, Zhejiang, China
【Abstract】 OBJECTIVE: To investigate the significance of changes in plasma levels of acute phase proteins (APPs) in patients with sepsis and severe sepsis by serial analysis. METHODS: Plasma contents of C reactive protein (CRP), a1-acid glycoprotein (AAG), ceruloplasmin (CER) and haptoglobin (HP) were determined by quantitative analysis in 29 sepsis and 27 severe sepsis patients on 1, 3, 7, 14 and 21 days using an American made specified protein automatic analyzer IMMAGE. The data were compared with those of 30 healthy persons. RESULTS:In sepsis group. CRP and AAG levels were found to be significantly increased on 1 day (P<0.01 and P<0.05). CRP level peaked on 3 days, while that of AAG peaked on 3 to 7 days. The peak of AAG level maintained for 2 weeks. There were significant differences in levels of CRP and AAG at different time points (both P<0.01). CER level was not increased (P>0.05). HP level increased significantly early (P<0.05), but there was no difference in HP between different time intervals (P>0.05). In severe sepsis group there was very marked increase in CRP and AAG different time intervals (both P<0.01). The high levels maintained for 14 days. There was significant difference in CRP and AAG levels between different time intervals (P<0.01).CER showed a tendency of lowering, and significant difference was found among different time points (P<0.05). HP did not increase significantly before 14 days (P>0.05) followed by a slow increase with significant difference among different time points (P<0.05). A comparison of tendency of changes between groups were significant differences in CRP, AAG and HP (all P<0.05). There was no significant difference in CER (P>0.05). CONCLUSION:Early increase in CRP was a sensitive sign for infection. The extended peaking of CRP and AAG levels indicates severe infection. Absence of increase in HP, or a reduction of it suggests also the presence of severe infection. CER is not a sensitive indicator of severity of infection. ......
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