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中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (02) : 213 -217. doi: 10.3877/cma.j.issn.1674-6902.2020.02.018

论著

重组人促血小板生成素改善脓毒症患者心肌损伤的临床研究
谢云1, 周志刚1,(), 田锐1, 金卫1, 谢晖1, 杜江1, 侯一珺1, 滕晓蕾1, 王瑞兰1,()   
  1. 1. 201620 上海市第一人民医院急诊危重病科
  • 收稿日期:2019-12-15 出版日期:2020-04-25
  • 通信作者: 周志刚, 王瑞兰
  • 基金资助:
    上海市卫生计生系统重要薄弱学科建设计划(2016ZB0205); 上海市科技支撑项目(18411950602); 上海市第一人民医院临床研究创新项目(CTCCR-2016B01); 吴阶平医学基金(320.6750.18546)

Effects of recombinant human thrombopoietin in improving myocardial injury in patients with sepsis

Yun Xie1, Zhigang Zhou1,(), Rui Tian1, Wei Jin1, Hui Xie1, Jiang Du1, Yijun Hou1, Xiaolei Teng1, Ruilan Wang1,()   

  1. 1. Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
  • Received:2019-12-15 Published:2020-04-25
  • Corresponding author: Zhigang Zhou, Ruilan Wang
引用本文:

谢云, 周志刚, 田锐, 金卫, 谢晖, 杜江, 侯一珺, 滕晓蕾, 王瑞兰. 重组人促血小板生成素改善脓毒症患者心肌损伤的临床研究[J]. 中华肺部疾病杂志(电子版), 2020, 13(02): 213-217.

Yun Xie, Zhigang Zhou, Rui Tian, Wei Jin, Hui Xie, Jiang Du, Yijun Hou, Xiaolei Teng, Ruilan Wang. Effects of recombinant human thrombopoietin in improving myocardial injury in patients with sepsis[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(02): 213-217.

目的

探讨脓毒症患者使用重组人促血小板生成素治疗后心肌损伤标志物、心功能、炎症因子水平等变化规律,以判断其对临床预后的作用。

方法

选择上海市第一人民医院急诊危重症医学科病房2016年1月至2019年4月收治的符合Sepsis3.0诊断标准的脓毒症患者186例,根据是否使用重组人促血小板生成素(rhTPO)将其分为对照组和rhTPO组。收集基本信息资料、临床数据资料、炎症因子和免疫功能指标预后生存状态等,主要监测指标为患者心肌损伤标志物TnI和心功能BNP,次要监测指标为炎症因子IL-6和TNF-α。

结果

使用rhTPO患者第七天心肌损伤指标血清心肌坏死标记物:心肌肌钙蛋白I(TnI)较未使用rhTPO患者下降幅度大(0.6471±0.4145 vs. 0.2517±0.1347μg/L,P=0.006) ;使用rhTPO患者第七天心功能指标脑钠肽BNP较未使用rhTPO患者下降幅度大(529.4±251.1 vs. 306.1±53.52 pg/ml,P<0.0001)。rhTPO可以降低反映内皮损伤的炎症因子IL-6、TNF-α。使用rhTPO患者第七天炎症指标IL-6较未使用rhTPO患者下降幅度明显增大(843.3±514.0 vs. 357.1±84.71 pg/ml,P<0.0001)。使用rhTPO患者第七天炎症指标TNF-α较未使用rhTPO患者下降幅度明显增大(9.771±9.051 vs. 5.850±1.621 pg/ml, P<0.0001)。

结论

rhTPO可以改善脓毒症心肌损伤、心功能,改善脓毒症炎症指标。

Objective

To investigate the changes of myocardial injury markers, cardiac functions and inflammatory cytokines in the patients with sepsis treated with recombinant human thrombopoietin (rhTPO), and to determine its effects on the clinical prognosis.

Methods

In this study, the patients with sepsis who met Sepsis 3.0 diagnostic criteria were collected from the Emergency Critical Care Medical Ward of Shanghai First People′s Hospital from January 2016 to April 2019 by retrospective observation method. According to whether they were treated with rhTPO, they were divided into an rhTPO group and a control group. The basic information, clinical data, inflammatory factors, indexes of immune functions, and prognosis conditions were collected. The main monitoring indexes for the patients were the myocardial injury marker Troponin I (TnI) and the cardiac function marker brain natriuretic peptide (BNP). The secondary monitoring indexes were inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Student′s t test was employed to treat the normal distribution data, the nonparametric test was employed to treat the abnormal distribution data, and Chi square test or Fisher inspection methods were employed to treat the counting data. And differences between the two groups were compared.

Results

A total of 186 patients with sepsis were included in this study, including 26 patients in the rhTPO group and 160 patients in the control group. On the 7th day of treatment of rhTPO, TnI (0.2517±0.1347 g/L in the rhTPO group vs. 0.6471±0.4145 g/L in the control group, P=0.006), BNP (306.1±53.52 pg/ml in the rhTPO group vs. 529.4±251.1 pg/ml in the control group, P<0.0001), IL-6 (357.1±84.71 pg/ml in the rhTPO group vs. 843.3±514.0 pg/ml in the control group, P<0.0001), and TNF-α (5.850±1.621 pg/ml in the rhTPO group vs. 9.771±9.051 pg/ml in the control group, P<0.0001) showed significant decreases in the patients of the rhTPO group compared with the patients in the control group.

Conclusion

The rhTPO can improve the myocardial injury, the cardiac functions and the inflammatory indexes of sepsis.

表1 两组脓毒症患者入组第1天指标比较(±s)
图1 两组脓毒症心肌缺血、心功能比较;注:**P<0.01,与对照组相比有显著统计学差异
图2 两组脓毒症炎症指标比较;注:**P<0.01,与对照组相比有显著统计学差异
1
Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock: 2016[J]. Crit Care Med, 2017, 43(3): 486-552.
2
Goldenberg NM, Steinberg BE, Slutsky AS, et al. Broken barriers: a new take on sepsis pathogenesis[J]. Science Translational Med, 2011, 3(88): 88ps25-88ps25.
3
Ait-Oufella H, Maury E, Lehoux S, et al. The endothelium: physiological functions and role in microcirculatory failure during severe sepsis[J]. Intens Care Med, 2010, 36(8):1286-1298.
4
Aird WC. The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome[J]. Blood, 2003, 101(10): 3765-3777.
5
Hippenstiel S, Suttorp N. Interaction of pathogens with the endothelium[J]. Thromb Haemost, 2003, 89(1): 18-24.
6
Gianfranco B. Endothelial tight junctions: permeable barriers of the vessel wall[J]. Thromb Haemost, 2006, 96(1): 36-42.
7
国家老年疾病临床医学研究中心(解放军总医院)  《感染诱发的老年多器官功能障碍综合征诊治中国专家共识》撰写组. 《感染诱发的老年多器官功能障碍综合征诊治中国专家共识》[J]. 中华老年多器官疾病杂志,2018, 17(1): 3-13.
8
Wu Q, Ren J, Wu X, et al. Recombinant human thrombopoietin improves platelet counts and reduces platelet transfusion possibility among patients with severe sepsis and thrombocytopenia: a prospective study[J]. J Crit Care, 2014, 29(3): 362-366.
9
Zakynthinos SG, Papanikolaou S, Theodoridis T, et al. Sepsis severity is the major determinant of circulating thrombopoietin levels in septic patients[J]. Crit Care Med, 2004, 32(4): 1004.
10
Segre E, Pigozzi L, Lison D, et al. May thrombopoietin be a useful marker of sepsis severity assessment in patients with SIRS entering the emergency department? [J]. Clin Chem Laboratory Med (CCLM), 2014: 1479-1483.
11
Lupia E, Bosco O, Mariano F, et al. Elevated thrombopoietin in plasma of burned patients without and with sepsis enhances platelet activation[J]. J Thromb Haemost, 2010, 7(6): 1000-1008.
12
Nawawi H, Osman NS, Annuar R, et al. Soluble intercellular adhesion molecule-1 and interleukin-6 levels reflect endothelial dysfunction in patients with primary hypercholesterolaemia treated with atorvastatin[J]. Atherosclerosis, 2003, 169(2): 283-291.
13
Tchinda VHM, Tadem AD, Tako EA, et al. Severe malaria in Cameroonian children: correlation between plasma levels of three soluble inducible adhesion molecules and TNF-α[J]. Acta Tropica, 2007, 102(1): 0-28.
14
Kaushansky K. Thrombopoietin[J]. N Engl J Med, 1998, 339(11): 746-754.
15
Van der Meeren A, Mouthon MA, Vandamme M, et al. Combinations of cytokines promote smvival of mice and limit acute aadiation damage in concert with amelioration of vascular damage[J]. Radiat Res, 2004, 161(5): 549-559.
16
Wu Q, Ren J, Wu X, et al. Recombinant human thrombopoietin improves platelet counts and reduces platelet transfusion possibility among patients with severe sepsis and thrombocytopenia: A prospective study[J]. J Crit Care, 2014, 29(3): 362-366.
17
Han JW, Kim KH, Kwun MJ, et al. Suppression of lung inflammation by the ethanol extract of Chung-Sang and the possible role of Nrf2[J]. BMC Complement Al tern Med, 2019, 19(1): 15.
18
Liu Z, Wang Y, Liu Y, et al. Typing of chronic ob structive pulmonary disease using high-resolution computed tomography and the association with smoking, arway inflammation,and common comorbidities[J]. Turk J Med Sci, 2018, 48(5): 945-951.
19
Cardier JE, Dempsey J. Thrombopoietin and its receptor, c-mpl, are constitutively expressed by mouse liver endothelial cells: evidence of thrombopoietin as a growth factor for liver endothelial cells[J]. Blood, 1998, 91(3): 923-929.
20
Stark AK, Sriskantharajah S, Hessel EM, et al. PI3K inhibitors in inflammation, autoimmunity and cancer[J]. Curr Opin Pharmacol, 2015, 23: 82-91.
21
Wang JY, Ye JY, Liang EY, et al. Thrombopoietin Prevents CoCl2-inducing Apoptosis of HUVEC through the PI3K/AKT Pathway[J]. J Exper Hematol, 2018, 26(2): 528.
22
Cheng HW, Chen YF, Wong JM, et al. Cancer cells increase endothelial cell tube formation and survival by activating the PI3K/Akt signalling pathway[J]. J Exper Clin Cancer Res, 2017, 36(1): 27.
23
Ramella R, Gallo MP, Spatola T, et al. A novel role of thrombopoietin as a physiological modulator of coronary flow[J]. Regulatory Peptides, 2011, 167(1): 5-8.
24
Chan KYY, Zhou L, Xiang P, et al. Thrombopoietin improved ventricular function and regulated remodeling genes in a rat model of myocardial infarction[J]. International Journal of Cardiology, 2013, 167(6): 2546-2554.
25
Baker JE, Su J, Koprowski S, et al. Thrombopoietin Receptor Agonists Protect Human Cardiac Myocytes from Injury by Activation of Cell Survival Pathways[J]. Journal of Pharmacology and Experimental Therapeutics, 2015, 352(3): 429-437.
26
Ilva T, Lund J, Porela P, et al. Early markers of myocardial injury: cTnI is enough[J]. Clinica Chimica Acta, 2009, 400(1-2): 0-85.
27
Grybauskiene R, Karciauskaite D, Brazdzionyte J, et al. Brain natriuretic peptide and other cardiac markers predicting left ventricular remodeling and function two years after myocardial infarction[J]. Medicina, 2007, 43(9): 708-715.
28
Singer M, Deutschman CS, Seymour CW, et al. The Third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8): 801-810.
29
Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock: 2016[J]. Intensive Care Med, 2017, 43(3): 304-377.
30
Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med, 2013, 39(2): 165-228.
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