血浆内皮糖萼成分作为预测脓毒症患者弥散性血管内凝血发展的潜在生物标志物。
Plasma Endothelial Glycocalyx Components as a Potential Biomarker for Predicting the Development of Disseminated Intravascular Coagulation in Patients With Sepsis.
机构信息
Department of Pulmonary and Critical Care Medicine and Intensive Care Unit, Binzhou Medical University Hospital, Binzhou, Shandong, China.
出版信息
J Intensive Care Med. 2021 Nov;36(11):1286-1295. doi: 10.1177/0885066620949131. Epub 2020 Aug 17.
BACKGROUND
Sepsis coagulopathy or disseminated intravascular coagulation (DIC) mainly due to progressive endothelial disruption and damage. The glycocalyx is expressed on the endothelial cell surface and contributes to anti-thrombogenicity, anti-inflammatory, and regulates vascular permeability. We aimed to evaluate the clinical utility of plasma glycocalyx components as biomarkers in predicting the onset of DIC in sepsis.
MATERIALS AND METHODS
This was a prospective observational study of 45 patients with sepsis (June to December 2018). Demographic, clinical (Acute Physiology, Age, Chronic Health Evaluation II [APACHE II], Sequential Organ Failure Assessment [SOFA]), and laboratory data from medical records were analyzed. Endothelial glycocalyx components (syndecan-1, heparan sulfate, hyaluronan) were measured using an ELISA kit.
RESULTS
Among the 45 patients (23, sepsis; 22, septic shock), plasma syndecan-1, heparan sulfate, and hyaluronan levels were higher in those with septic shock and were positively correlated with disease severity as determined by the APACHE II and SOFA scores and lactate levels. Receiver operating characteristic curve analysis revealed high sensitivity and specificity of syndecan-1 for predicting septic shock. Further, these levels were compared between patients with or without the development of DIC. Plasma syndecan-1 and hyaluronan levels were significantly elevated in patients with DIC compared to those in patients without DIC and were strongly associated with activated partial thromboplastin time, prothrombin time, and platelet counts. Area under the curve values for predicting DIC based on syndecan-1 and hyaluronan levels measurements were 0.774 and 0.740, respectively.
CONCLUSIONS
Increased plasma syndecan-1 and hyaluronan levels may be indicators of disease severity and useful predictors for DIC development in sepsis.
背景
脓毒症凝血功能障碍或弥散性血管内凝血（DIC）主要是由于内皮细胞不断受到破坏和损伤。糖萼位于内皮细胞表面，有助于抗血栓形成、抗炎，并调节血管通透性。我们旨在评估血浆糖萼成分作为预测脓毒症患者 DIC 发生的生物标志物的临床效用。
材料和方法
这是一项对 45 例脓毒症患者（2018 年 6 月至 12 月）进行的前瞻性观察性研究。对病历中的人口统计学、临床（急性生理学、年龄、慢性健康评估 II [APACHE II]、序贯器官衰竭评估 [SOFA]）和实验室数据进行分析。使用 ELISA 试剂盒测量内皮糖萼成分（连接蛋白-1、硫酸乙酰肝素、透明质酸）。
结果
在 45 例患者中（23 例脓毒症，22 例脓毒性休克），脓毒性休克患者的血浆连接蛋白-1、硫酸乙酰肝素和透明质酸水平较高，与 APACHE II 和 SOFA 评分以及乳酸水平确定的疾病严重程度呈正相关。受试者工作特征曲线分析显示，连接蛋白-1 对预测脓毒性休克具有较高的敏感性和特异性。此外，还比较了这些水平在发生 DIC 的患者和未发生 DIC 的患者之间的差异。与未发生 DIC 的患者相比，发生 DIC 的患者的血浆连接蛋白-1 和透明质酸水平明显升高，并且与活化部分凝血活酶时间、凝血酶原时间和血小板计数密切相关。基于连接蛋白-1 和透明质酸水平测量值预测 DIC 的曲线下面积值分别为 0.774 和 0.740。
结论
血浆连接蛋白-1 和透明质酸水平升高可能是疾病严重程度的指标，并且对脓毒症患者 DIC 的发生具有预测价值。
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