黄谦　张文广　蔡纯雁　邓烈华

【摘要】 目的：探討中性粒细胞来源微粒AnxA1、CD11b及CD62L水平在判断烧伤脓毒症患者病情严重程度及预后中的作用，为烧伤脓毒症的诊疗提供理论依据。方法：选取2014年7月-2017年6月本院体检中心的20例健康人员（对照组），同时搜集28例重度烧伤合并脓毒症患者（脓毒症组）、11例重度烧伤合并重症脓毒症患者（脓毒症休克组）。在第1、3、7天采集所有参与人员的血标本，采用流式细胞术检测血浆中性粒细胞来源微颗粒（AnxA1、CD11b、CD62L）并计算其绝对个数，同步记录急性生理学与慢性健康状况评分Ⅱ（APACHE Ⅱ评分），并统计机械通气时间、总住院时间、病死率。结果：三组患者的中性粒细胞来源微颗粒（AnxA1、CD11b及CD62L）水平比较，差异均有统计学意义（P<0.05）。脓毒症组及脓毒症休克组的AnxA1、CD11b及CD62L均高于对照组（P<0.05）；而脓毒症休克组的AnxA1低于脓毒症组（P<0.05），CD11b及CD62L均高于脓毒症组（P<0.05）。通过血浆中性粒细胞来源微颗粒及APACHE Ⅱ评分的动态变化可知，脓毒症组及脓毒症休克组患者的AnxA1水平在治疗期间无明显变化，而CD11b及CD62L水平均有所升高，APACHE Ⅱ评分则呈下降趋势。脓毒症组机械通气时间、总住院时间均短于脓毒症休克组（P<0.05），病死率低于脓毒症休克组，但差异无统计学意义（P>0.05）。结论：中性粒细胞来源微粒AnxA1、CD11b及CD62L可早期对烧伤脓毒症患者的病情程度及预后进行预测，为烧伤脓毒症患者的诊疗提供参考。

【关键词】 中性粒细胞来源微粒； 烧伤脓毒症； 病情程度

Diagnostic Value of Neutrophil Derived Micro-particles AnxA1，CD11b and CD62L in Burn Sepsis/HUANG Qian，ZHANG Wenguang，CAI Chunyan，et al.//Medical Innovation of China，2018，15（17）：057-060

【Abstract】 Objective：To investigate the role of AnxA1，CD11b and CD62L levels in neutrophil derived micro-particles in determining the severity and prognosis of burn sepsis patients and provide a theoretical basis for the diagnosis and treatment of burn sepsis.Method：From July 2014 to June 2017，20 healthy subjects （control group） in the physical examination center of our hospital were selected，28 patients with severe burn and sepsis （sepsis group） were collected，severe burn combined with severe sepsis symptomatic patients in 11 cases（septic shock group） were selected.Blood samples of all the participants were collected on the 1st，3rd and 7th day，the plasma neutrophil granulocytes（AnxA1，CD11b and CD62L） were detected by flow cytometry and their absolute numbers were counted.The Acute Physiology and Chronic Health Score（APACHE Ⅱ score），mechanical ventilation time，total length of stay，and mortality were calculated.Result：The levels of AnxA1，CD11b and CD62L in neutrophil derived micro-particles were significantly different among the three groups（P<0.05）.The levels of AnxA1，CD11b and CD62L in sepsis group and septic shock group were higher than those in control group（P<0.05）；the AnxA1 of septic shock group was lower than that of septic shock group （P<0.05），CD11b and CD62L were higher than those in sepsis group（P<0.05）.The dynamic changes of plasma neutrophil derived micro-particles and APACHE Ⅱ scores were observed，the level of AnxA1 in sepsis group and septic shock group did not change significantly during the treatment period，while the levels of CD11b and CD62L increased，the APACHE Ⅱ score showed a downward trend.The duration of mechanical ventilation and total hospital stay in sepsis group were shorter than those in septic shock group（P<0.05），the mortality was lower than that in septic shock group，but there was no significant difference（P>0.05）.Conclusion：The neutrophil derived micro-particles AnxA1，CD11 and CD62L can predict the degree and prognosis of burn sepsis in the early stage，and provide reference for the diagnosis and treatment of patients with burn sepsis.

【Key words】 Neutrophil derived micro-particles； Burn sepsis； Severity of illness

First-authors address：Longhua District Peoples Hospital in Shenzhen City，Shenzhen 518109，China

doi：10.3969/j.issn.1674-4985.2018.17.015

脓毒症是一种全身炎症反应综合征，严重感染引发的脓毒症是目前严重烧伤最常见的死亡原因[1]。早期诊断、积极预防是脓毒症治疗的关键，因此，需要找到一些能够及早诊断脓毒症并评估其预后的生物标记物，使烧伤脓毒症得到最早最佳的治疗方案，以降低其死亡率。目前，临床上主要采用C反应蛋白、降钙素原指标判断脓毒症患者的病情程度，但其敏感性、特异性仍需进一步研究[2]。有国外文献提示，中性粒细胞来源微粒（AnxA1、CD11b及CD62L）在脓毒症患者中具有重要的临床意义[3]。……