血必净注射液对脓毒症患者血小板活化因子CD62P和CD63的影响

Effect of Xuebijing injection on platelet activating factors CD62P and CD63 in patients with sepsis and its mechanism

摘要:

目的 探讨血必净注射液对脓毒症患者血小板活化水平的影响。方法 选取2019年6月—2020年1月潍坊医学院附属医院抢救监护室（EICU）、重症监护治疗病房（ICU）收治的脓毒症患者42例进行前瞻性队列研究。通过随机分配原则将其分为常规治疗组与血必净组。收集患者入院24 h的基础资料及临床数据，同时比较两组的基础资料、CD62P和CD63的阳性表达率、序贯性器官功能衰竭评分（SOFA评分）和急性生理与慢性健康状况评分（APACHE Ⅱ评分）；采用Spearman法分析CD62P和CD63与凝血相关指标、SOFA评分及APACHE Ⅱ评分之间的相关性；采用多因素Logistic回归分析脓毒症患者14 d全因死亡的独立危险因素。结果 两组患者的年龄、性别、高血压、糖尿病、肾病、心脑血管病、感染部位比较，差异无统计学意义（P >0.05）。常规治疗组与血必净组治疗第8天临床资料比较，血必净组血小板计数水平升高（P <0.05），降钙素原（PCT）水平、中性粒细胞百分比（NEUT%）水平、纤维蛋白原（FIB）水平、凝血酶原时间（PT）水平、部分活化凝血酶时间（APTT）水平、APACHE Ⅱ评分、SOFA评分、病死率、住院时间、CD62P阳性表达率、CD63阳性表达率下降（P <0.05）。Spearman相关性分析结果显示，血小板活化因子CD62P和CD63的阳性表达率与血小板计数水平呈负相关（P <0.05），CD62P和CD63阳性表达与PT水平、APTT水平、SOFA评分、APACHE Ⅱ评分呈正相关（P <0.05）。多因素Logistic回归分析发现，CD62P和CD63阳性表达是脓毒症患者14 d死亡的独立危险因素（P <0.05），血小板计数水平是其独立保护因素（P <0.05）。结论 血必净注射液可能通过抑制脓毒症患者血小板活化因子CD62P、CD63的阳性表达率，降低血小板活化水平，从而降低14 d全因死亡率，改善脓毒症患者的近期预后。

Abstract:

Objective To investigate the positive expression rate of platelet activating factor CD62P and CD63, and to discuss the effect of Xuebijing Injection on platelet activation level in sepsis patients and the mechanism of Xuebijing Injection on sepsis patients.Methods From June 2019 to January 2020, 42 patients with sepsis admitted to EICU and ICU of Weifang Medical University were randomly divided into routine treatment group and Xuebijing group. Basic data and clinical data of sepsis patients were collected within 24 hours after admission. At the same time, the basic data, CD62P, CD63, sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) of the two groups were compared. The correlation of CD62P and CD63 with coagulation related index, SOFA, and APACHE Ⅱ was analyzed. Finally, the independent risk factors of all-cause death in 14 days were analyzed by multivariate logistic regression.Results There was no significant difference in age, gender, past disease history (hypertension, diabetes, nephropathy, cardiovascular and cerebrovascular diseases) and infection site between the two groups (P > 0.05). Compared with Xuebijing group on the 8th day of treatment, the platelet count in Xuebijing group was significantly higher than conventional treatment group, which was statistically significant by t test (P < 0.05). Procalcitonin (PCT) level, neutrophil percentage (neut%) level, fibrinogen (FIB) level, prothrombin time (PT) level, partial activated thromboplastin time (APTT) level, APACHE Ⅱ score, SOFA score, mortality, length of hospital stay, CD62P level, and CD63 level were significantly decreased (P <0.05). Spearman correlation analysis showed that platelet activating factor CD62P and CD63 levels were negatively correlated with PLT count level (P < 0.05), and CD62P level and CD63 level were positively correlated with PT level, APTT level, SOFA score, and APACHE Ⅱ score (P < 0.05). Multivariate logistic regression analysis showed that the levels of CD62P and CD63 were independent risk factors of sepsis (P < 0.05), and PLT count was an independent protective factor (P < 0.05).Conclusion Xuebijing injection may reduce the level of platelet activation by inhibiting the positive expression rate of CD62P and CD63 in sepsis patients, so as to reduce the 14-day all-cause mortality and improve the short-term prognosis of sepsis patients.