芳菲

【摘要】 目的：分析膿毒症患儿不同血糖水平对脏器损伤、氧化应激反应及Wnt5a炎症通路的影响。方法：收集2016年9月-2017年8月笔者所在医院收治的90例脓毒症患儿治疗资料进行回顾性分析。参照患儿血糖水平分为脓毒症1组39例（血糖>10 mmol/L），脓毒症2组51例（血糖≤10 mmol/L），同时选取于笔者所在医院接种的健康儿童50例为健康组。入院当日，检测肝功能指标、氧化应激指标及Wnt5a炎症通路指标。结果：脓毒症1组和脓毒症2组谷草转氨酶（AST）、总胆红素（TBIL）及谷丙转氨酶（ALT）均明显高于健康组，且脓毒症1组AST、TBIL及ALT均明显高于脓毒症2组，差异均有统计学意义（P<0.05）。脓毒症1组和脓毒症2组丙二醛（MDA）、高级氧化蛋白产物（AOPPs）、活性氧簇（ROS）及脂质过氧化氢（LHP）均明显高于健康组，且脓毒症1组MDA、AOPPS、ROS及LHP均明显高于脓毒症2组，差异均有统计学意义（P<0.05）;脓毒症1组和脓毒症2组谷胱甘肽过氧化物酶（GSH-Px）均明显低于健康组，且脓毒症1组GSH-Px明显低于脓毒症2组，差异均有统计学意义（P<0.05）。脓毒症1组和脓毒症2组血清MIP-1β、IL-1β、IL-12及IL-6均明显高于健康组，且脓毒症1组MIP-1β、IL-1β、IL-12及IL-6均明显高于脓毒症2组，差异均有统计学意义（P<0.05）。结论：高血糖的脓毒症患儿肝功能损伤程度较为严重，氧化应激和炎症反应较大，可作为脓毒症病情严重和预后效果欠佳的可靠指标。

【关键词】 脓毒症 不同血糖水平 肝功能损伤 氧化应激反应 Wnt5a炎症通路 影响

doi：10.14033/j.cnki.cfmr.2019.29.023 文献标识码 B 文章编号 1674-6805（2019）29-00-03

[Abstract] Objective： To analyze the effects of different blood glucose levels on organ injury， oxidative stress reaction and Wnt5a inflammatory pathway in children with sepsis. Method： Data of 90 children with sepsis admitted to our hospital from September 2016 to August 2017 were collected for retrospective analysis. According to the blood glucose level， 39 children in the sepsis group 1 （blood glucose>10 mmol/L） and 51 children in the sepsis group 2 （blood glucose≤10 mmol/L）. Meanwhile， 50 healthy children inoculated in our hospital were selected as the healthy group. On the day of admission， the indexes of liver function， oxidative stress and Wnt5a inflammatory pathway were tested. Result： Glutamic-oxaloacetic transaminase （AST）， total bilirubin （TBIL） and glutamic-pyruvic transaminase （ALT） in the sepsis group 1 and the sepsis group 2 were significantly higher than those of the healthy group， and AST， TBIL and ALT in the sepsis group 1 were significantly higher than those of the sepsis group 2， and the differences were statistically significant （P<0.05）. Malondialdehyde （MDA）， high oxidative protein products （AOPPs）， reactive oxygen species （ROS） and lipid hydrogen peroxide （LHP） in the sepsis group 1 and the sepsis group 2 were significantly higher than those of the healthy group， and MDA， AOPPs， ROS， LHP in the sepsis group 1 were significantly higher than those of the sepsis group 2， and the differences were statistically significant （P<0.05）. Glutathione peroxidase （GSH-Px） in the sepsis group 1 and the sepsis group 2 were significantly lower than those of the healthy group， and GSH-Px in the sepsis group 1 were significantly lower than that of the sepsis group 2， and the differences were statistically significant （P<0.05）. Serum MIP-1β， IL-1β， IL-12 and IL-6 in the sepsis group 1 and the sepsis group 2 were significantly higher than those of the healthy group， and MIP-1β， IL-1β， IL-12 and IL-6 in the sepsis group 1 were significantly higher than those of the sepsis group 2 group， and the differences were statistically significant （P<0.05）. Conclusion： The degree of liver function damage in children with sepsis with hyperglycemia is more serious， and oxidative stress and inflammatory reaction are large， which can be used as a reliable indicator of severe condition and poor prognosis of sepsis.

[Key words] Sepsis Different blood glucose levels Liver function damage Oxidative stress reaction Wnt5a inflammatory pathway Impact

First-authors address： Xiangyang NO.1 Peoples Hospital， Affiliated Hospital of Hubei University of Medicine， Xiangyang 441000， China

脓毒症为感染导致的全身性炎症反应综合征，具有死亡率高的显著特征[1]。相关资料显示，当前脓毒症患者死亡率已高达30%以上[2]。早期鉴别脓毒症严重程度是选择治疗方式的基础与前提，方便、准确的鉴别指标是当前临床关注的重点[3-5]。本研究深入分析不同血糖水平对于脓毒症患儿脏器损伤、Wnt5a炎症通路及氧化应激反应带来的影响，旨在为脓毒症早期鉴别指标的选择提供可靠依据，进行如下报道。

1 资料与方法

1.1 一般资料

收集2016年9月-2017年8月笔者所在医院收治的90例脓毒症患儿治疗资料进行回顾性分析。纳入标准：符合WHO脓毒症相关诊断标准。排除标准：精神类疾病;恶性肿瘤。参照患儿血糖水平分为脓毒症1组39例（血糖>10 mmol/L），脓毒症2组51例（血糖≤10 mmol/L），同时选取于笔者所在医院接种的健康儿童50例为健康组。脓毒症……