蛋白酶抑制剂联合CRRT对脓毒症患者FABP3、GPBB水平的影响

王妙淑 宋于康 孙仁华 杨向红

[摘要] 目的 探討蛋白酶抑制剂联合连续肾脏代替治疗（CRRT）对脓毒症患者心型脂肪酸结合蛋白（FABP3）、糖原磷酸化酶同工酶BB（GPBB）水平的影响。 方法 选取2019年2月至2020年6月我院收治的脓毒症患者134例，按照随机数字表法分为CRRT组与联合治疗组，每组各67例。其中CRRT组患者进行CRRT治疗，联合治疗组患者进行CRRT联合蛋白酶抑制剂进行治疗。使用流式细胞仪对CD4+、CD8+、CD4+/CD8+指标水平进行测定与比较，采用酶联免疫法检测白介素-8（IL-8）、肿瘤细胞因子-α（TNF-α）、白介素-6（IL-6）及脂肪酸结合蛋白3（FABP3）、糖原磷酸化酶同工酶BB（GPBB）水平，并比较，免疫组化法检测D-乳酸、二胺氧化酶（DAO）水平，并对两组患者治疗疗效进行评价。 结果 治疗后，与CRRT组相比，联合治疗组CD4+指标水平与CD4+/CD8+均较高，CD8+指标水平较低（P<0.05）;与CRRT组相比，联合治疗组IL-8、TNF-α、IL-6水平均较低（P<0.05）;联合治疗组D-乳酸水平及DAO水平均低于CRRT组（P<0.05）;与CRRT组相比，联合治疗组FABP3水平较高、GPBB水平较低（P<0.05）;与CRRT组相比，联合治疗组治疗总有效率较高（P<0.05）。 结论 使用蛋白酶抑制剂联合CRRT对脓毒症患者进行治疗，能够显著改善患者免疫功能，抑制炎症反应，同时能够降低肠道黏膜损害程度，使得FABP3水平升高、GPBB水平降低，从而减轻脓毒症患者心肌损伤程度。

[关键词] 蛋白酶抑制剂;脓毒症;连续性肾脏替代疗法;白介素-8;心型脂肪酸结合蛋白;糖原磷酸化酶同工酶BB

[中图分类号] R593.2          [文献标识码] A          [文章编号] 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.