目的观察外科严重感染患者内源性杀菌/通透性增加蛋白(BPI)的变化规律及其临床意义。方法筛选外科严重感染患者19例,分别于感染前和感染后第1、3、5、7、14天采集血标本。采用ELISA方法测定血浆BPI、脂多糖结合蛋白(LBP)和白细胞介素-6(IL-6)水平;内毒素含量采用改良基质显色法鲎试验检测。同时检查感染前及感染后第1、3、5、7、14天的中性粒细胞计数,并观察患者预后。结果与正常对照组比较,脓毒症组患者感染后第1~5天血浆中BPI/LBP比值明显降低(P〈0.01),第7天恢复至正常范围;严重脓毒症组患者感染后第1~7天其比值显著降低(P〈0.01)。此外,感染后第1~3天严重脓毒症组血浆中BPI/LBP比值显著低于脓毒症组(P〈0.05)。结论外科感染时机体内源性BPI和LBP水平迅速升高,但BPI的增幅明显低于LBP;感染早期BPI/LBP比值与脓毒症病情的严重程度密切相关。
Objective To investigate changes in endogenous bactericidal/permeability-increasing protein ( BPI ) levels and their significance in patients with surgical sepsis. Methods In the prospective study, 19 surgical patients with infection were involved. The plasma BPI, lipopolysaccharide-binding protein (LBP) and interleukin-6 levels were measured on post-infected days 1, 3, 5,7 and 14 by an enzyme-linked immunosorbent assay (ELISA). Plasma endotoxin concentrations were determined by the modified chromogenic Limulus Amebecyte Lysate (LAL). Results Compared with normal controls, significant lower plasma BPI/LBP ratios were observed in septic patients on days 1 to 5 after infection ( P 〈 O. O1 ), and in severe septic patients on days 1 to 7 ( P 〈 O. O1 ). Moreover, plasma BPI/LBP ratios were much lower in severe sepsis than those in sepsis on days 1 to 3 after infection ( P 〈 O. 05 ). Condusions Plasma BPI and LBP levels increased rapidly after infection, hut BPI/LBP ratios were significantly decreased during sepsis. Plasma BPI/LBP ratios appear to be closely related to the severity of sepsis in patients complicated by surgical infection.