不同细菌感染致脓毒症患者血小板减少差异原因分析_晏峰

文章编号：1673-8640（2015）02-0137-04中图分类号：Ｒ446．11文献标志码：A DOI：10．3969/j．issn．1673-8640．2015．02．008不同细菌感染致脓毒症患者血小板减少差异原因分析

晏峰，任振焕，周颖

（丽水市人民医院检验科，浙江丽水323000）

摘要：目的初步分析细菌感染致脓毒症患者血小板（PLT）减少原因，并研究区分革兰阳性（G+）细菌与革兰阴性（G－）细菌生化特征，为临床早期预防多器官衰竭，降低死亡率提供依据。方法检测155例脓毒症患者组、56例非脓毒血症患者（感染组）和43例非感染对照组的血小板计数、降钙素原（PCT）、C-反应蛋白（CＲP）、白细胞（WBC）、中性粒细胞（NE）百分比及Bcl-xL蛋白水平，对上述3组患者的6项指标进行统计学分析。同时进行血细菌培养，将75例血培养阳性的脓毒症患者分为G+组和G－组，检测分析2组间PLT、PCT结果、Bcl-xL蛋白水平及在不同PCT截值的百分比。结果脓毒症患者组生化指标与对照组相比差异均有统计学意义（P＜0．01）；与感染组比较，PLT、PCT、CＲP和Bcl-xL水平差异均有统计学意义（P＜0．01），WBC和中性粒细胞百分比差异均无统计学意义（P＞0．05）；感染组患者PCT、CＲP、WBC、中性粒细胞百分比与对照组相比，差异均有统计学意义（P＜0．01），但PLT和Bcl-xL差异均无统计学意义（P＞0．05）。同时发现，G+细菌与G－细菌脓毒症患者在PCT＜2．0ng/mL时，百分率差异无统计学意义（P＞0．05）；2．0ng/mL≤PCT≤10．0ng/mL时，G+组患者的百分率明显高于G－组（P＜0．01）；而在PCT≥10．0ng/mL时，G－组患者百分率明显高于G+组（P＜0．01）。G－细菌性脓毒症组PLT、PCT水平均低于G+细菌性脓毒症组（P＜0．01）。结论脓毒症患者出现PLT减少、PCT 升高与细菌作用于Bcl-xL启动PLT凋亡程序有关；G－细菌致脓毒症较G+细菌更易启动PLT凋亡，具有更高危险性。

关键词：脓毒症；血小板减少；Bcl-xL蛋白

Difference cause analysis on thrombocytopenia by different bacterial infections in patients with sepsis YAN Feng，ＲEN Zhenhuan，ZHOU Ying．（Department of Clinical Laboratory，Lishui City People's Hospital，Zhejiang Lishui323000，China）

Abstract：Objective To analyze primarily the difference causes of thrombocytopenia by different bacterial infections in patients with sepsis，to distinguish the biochemical characteristics of Gram-positive bacteria（G+）and Gram-negative bacteria（G－），and to provide the reference for the clinical early prevention of multiple organ failure and reduce the mortality rate．Methods A total of155sepsis patients，56patients with non-sepsis（infection group）and 43non-infected controls were enrolled，and their platelet（PLT），procalcitonin（PCT），C reactive protein（CＲP），white blood cell（WBC），the percentage of neutrophils（NE）and Bcl-xL protein levels were determined．The results were analyzed statistically．Blood culture was performed simultaneously，75cases of blood culture-positive sepsis patients were classified into G+and G－groups．Their PLT，PCT，Bcl-xL protein and different PCT cross-section percentages were analyzed．Ｒesults Biochemical parameters of sepsis group had obvious difference with those of control group（P＜0．01）．Compared with infection group，serum PLT，PCT，CＲP and Bcl-xL protein levels were significantly different（P＜0．01），and WBC and the percentage of NE had no statistical significance（P＞0．05）．In infection group，PCT，CＲP，WBC，NE percentage had statistical significance compared with those in control group（P＜0．01），but the differences of PLT and Bcl-xL protein were not significant（P＞0．05）．For G+and G－groups in sepsis patients，when PCT＜2．0ng/mL，there was no statistical significance（P＞0．05）．When2．0ng/mL≤PCT≤10．0ng/mL，the percentage in G+group was significantly higher than that in G－group（P＜0．01）．When PCT≥10．0ng/mL，the percentage in G-group was significantly higher than that in G+group（P＜0．01）．PLT and PCT levels in G－group were lower than those in G+group（P＜0．01）．Conclusions The reduction of PLT and the increase of PCT are related to the apoptosis of PLT caused by Bcl-xL protein．G－sepsis is easier to start PLT apoptosis than G+sepsis with higher risk．

Key words：Sepsis；Thrombocytopenia；Bcl-xL protein

作者简介：晏峰，男，1975年生，硕士，副主任技师，主要从事临床生化检验工作。