王妙淑 宋于康 孫仁華 楊向紅

[摘要] 目的 探討蛋白酶抑制劑聯(lián)合連續(xù)腎臟代替治療（CRRT）對(duì)膿毒癥患者心型脂肪酸結(jié)合蛋白（FABP3）、糖原磷酸化酶同工酶BB（GPBB）水平的影響。 方法 選取2019年2月至2020年6月我院收治的膿毒癥患者134例，按照隨機(jī)數(shù)字表法分為CRRT組與聯(lián)合治療組，每組各67例。其中CRRT組患者進(jìn)行CRRT治療，聯(lián)合治療組患者進(jìn)行CRRT聯(lián)合蛋白酶抑制劑進(jìn)行治療。使用流式細(xì)胞儀對(duì)CD4+、CD8+、CD4+/CD8+指標(biāo)水平進(jìn)行測(cè)定與比較，采用酶聯(lián)免疫法檢測(cè)白介素-8（IL-8）、腫瘤細(xì)胞因子-α（TNF-α）、白介素-6（IL-6）及脂肪酸結(jié)合蛋白3（FABP3）、糖原磷酸化酶同工酶BB（GPBB）水平，并比較，免疫組化法檢測(cè)D-乳酸、二胺氧化酶（DAO）水平，并對(duì)兩組患者治療療效進(jìn)行評(píng)價(jià)。 結(jié)果 治療后，與CRRT組相比，聯(lián)合治療組CD4+指標(biāo)水平與CD4+/CD8+均較高，CD8+指標(biāo)水平較低（P<0.05）;與CRRT組相比，聯(lián)合治療組IL-8、TNF-α、IL-6水平均較低（P<0.05）;聯(lián)合治療組D-乳酸水平及DAO水平均低于CRRT組（P<0.05）;與CRRT組相比，聯(lián)合治療組FABP3水平較高、GPBB水平較低（P<0.05）;與CRRT組相比，聯(lián)合治療組治療總有效率較高（P<0.05）。 結(jié)論 使用蛋白酶抑制劑聯(lián)合CRRT對(duì)膿毒癥患者進(jìn)行治療，能夠顯著改善患者免疫功能，抑制炎癥反應(yīng)，同時(shí)能夠降低腸道黏膜損害程度，使得FABP3水平升高、GPBB水平降低，從而減輕膿毒癥患者心肌損傷程度。

[關(guān)鍵詞] 蛋白酶抑制劑;膿毒癥;連續(xù)性腎臟替代療法;白介素-8;心型脂肪酸結(jié)合蛋白;糖原磷酸化酶同工酶BB

[中圖分類號(hào)] R593.2? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-9701（2021）24-0006-04

Effect of protease inhibitors combined with CRRT on FABP3 and GPBB levels in patients with sepsis

WANG Miaoshu1? ?SONG Yukang1? ?SUN Renhua2? ?YANG Xianghong2

1.Department of Intensive Care Unit， the First People′s Hospital of Wenling City in Zhejiang Province， Wenling? ?317500， China; 2.Department of Intensive Care Unit， Zhejiang Provincial People′s Hospital， Hangzhou? ?310014， China

[Abstract] Objective To explore the effect of protease inhibitors combined with continuous renal replacement therapy （CRRT） on heart fatty acid binding protein （FABP3） and glycogen phosphorylase isoenzyme BB （GPBB） levels in patients with sepsis. Methods A total of 134 patients with sepsis admitted to our hospital from February 2019 to June 2020 were selected and divided into the CRRT group and the combined treatment group according to the random number table，with 67 cases in each group. Patients in the CRRT group were treated with CRRT，and patients in the combined treatment group were treated with CRRT combined with protease inhibitors. The levels of CD4+， CD8+ and CD4+/CD8+ were measured and compared by flow cytometry. The levels of interleukin-8 （IL-8）， tumor cytokine-α（TNF-α）， interleukin-6 （IL-6）， fatty acid binding protein 3 （FABP3）， and glycogen phosphorylase isoenzyme BB （GPBB） were measured and compared by enzyme-linked immunosorbent assay.The levels of D-lactate and diamine oxidase （DAO） were measured by immunohistochemistry. The therapeutic efficacy was evaluated in the two groups. Results After treatment，compared with the CRRT group， CD4+ level and CD4+/CD8+ were higher and CD8+ level was lower in the combined treatment group（P<0.05）. Compared with the CRRT group， IL-8，TNF-α and IL-6 levels were lower in the combined treatment group（P<0.05）. D-lactate level and DAO level were lower in the combined treatment group（P<0.05）.Compared ith the CRRT group， the FABP3 level was higher and the GPBB level was lower in the combined treatment group（P<0.05）. The total treatment response rate was higher in the combined treatment group（P<0.05）. Conclusion Protease inhibitors combined with CRRT in the treatment of patients with sepsis can significantly improve the immune function， inhibit the inflammatory response，reduce the degree of intestinal mucosal damage， increase the level of FABP3 and decrease the level of GPBB， thereby reducing the degree of myocardial injury in patients with sepsis.