| Objectives To observe the dynamic changes of serum amyloid A(SAA),soluble myeloid cell trigger receptor-1(sTREM-1)and high mobility group protein B-1(HMGB-1)in sepsis patients after heparin intervention,and to explore the effect of heparin on venous blood SAA,sTREM-1 and HMGB-1 in sepsis patients and its clinical significance.Methods 1 Research object 100 patients who met the diagnostic criteria of sepsis were selected from the Affiliated Hospital of North China University of Technology from November 2017 to November 2018.They were divided into heparin group(50 cases)and control group(50 cases)according to random number table.According to the 28-day mortality rate,the two groups were divided into survival group and death group.There were 34 cases in the heparin group,16 cases in the heparin group and 16 cases in the control group.The survival rate was 28 cases and the death rate was 22 cases.All subjects were treated with cluster therapy,and the heparin group was subcutaneously injected with low molecular weight heparin 5000 for 1 day on the basis of cluster therapy for sepsis.2Research methods Collect the clinical data of age(age),sex(male/female),body mass index(BMI),course of disease and so on.All the patients were assessed by sequential organ failure assessment(SOFA)before treatment and 5 days after intervention,and the levels of leukocytes,lactic acid,procalcitonin and C-reactive protein were recorded before and 5 days after intervention.The levels of SAA,sTREM-1 and HMGB-1 in venous blood of heparin group and control group were measured by enzyme linked immunosorbent assay(ELISA)before and on the 3rd and 5th days after heparin administration.All data were analyzed by SPSS19.0 statistical software,P < 0.05 was statistically significant.Results 1 Baseline 1)There was no significant difference in age,sex composition and body mass index(BMI)between heparin group and control group(P > 0.05).2.The effect of heparin therapy on SAA,sTREM-1 and HMGB-1 in sepsis patients 1)The effect on SAA:(1)Before intervention,there was significant difference in SAA level between the two groups(P =0.05).(2)Comparison of SAA levels at different observation points after intervention with those before intervention: SAA levels in heparin group and control group decreased 3 days after intervention and 5 days after intervention,and the decrease degree in heparin group was significantly higher than that in control group on the 5th day after intervention,and the decrease degree in heparin group was better than that in control group,with statistical significance(P < 0.05).2)The effect on sTREM-1:(1)Before intervention,there was no significant difference in sTREM-1 level between the two groups(P > 0.05).(2)The difference of sTREM-1 levels at different observation points after intervention and before intervention was compared.The levels of sTREM-1 in heparin group and control group decreased 3 days after intervention and 5 days after intervention,and the level of sTREM-1 in heparin group was significantly higher than that in control group on the 5th day after intervention,and the level of sTREM-1 in heparin group was better than that in control group(P < 0.05).3)The influence on HMGB-1:(1)Before intervention,there was no significant difference in the level of HMGB-1 between the two groups(P > 0.05).(2)The difference of HMGB-1 level between different observation points after intervention and before intervention: The HMGB-1 level of heparin group and control group decreased3 days after intervention and 5 days after intervention,and the decrease degree of heparin group was significantly higher than that of control group on the 5th day after intervention,and the decrease degree of heparin group was better than that of control group,withsignificant difference(P < 0.05).Evaluation of clinical indicators: There was no significant difference in SOFA score,Lac,WBC,PCT and CRP levels between the two groups before intervention,indicating that the clinical indicators of the two groups before intervention were comparable(P > 0.05).After intervention,the SOFA score,Lac,WBC,PCT and CRP levels of the two groups all decreased.From the numerical point of view,the decrease degree of the heparin group was greater than that of the control group,and the effect was better.2)Prognostic evaluation: The 28-day mortality rate of heparin group was 32%(16/50)higher than that of control group 44%(22/50),with no significant difference(P >0.05),indicating that heparin could not be considered to have an impact on the prognosis of sepsis patients;the levels of SAA,sTREM-1 and HMGB-1 in death group were higher than those in survival group,with significant difference(P < 0.05).4 The serum SAA level was positively correlated with WBC,lactic acid,procalcitonin,C-reactive protein,SOFA score before intervention in all patients,r = 0.944,0.984,0.977,0.972,0.968,P < 0.05;plasma sTREM-1 level was positively correlated with WBC,lactic acid,procalcitonin,Creactive protein and SOFA score,r = 0.952,0.947,0.961,0.940,0.966,P < 0.05;-Level 1was positively correlated with WBC,lactic acid,procalcitonin,C-reactive protein and SOFA score,r = 0.964,0.968,0.980,0.972,0.969,P < 0.05.The results showed that SAA was positively correlated with sTREM-1,the correlation coefficient r =0.933,P <0.05;SAA was positively correlated with HMGB-1,the correlation coefficient r =0.980,P <0.05;sTREM-1 was positively correlated with HMGB-1,the correlation coefficient r= 0.950,P<0.05.Conclusions Low molecular weight heparin can decrease the levels of serum SAA,sTREM-1 and HMGB-1 in sepsis patients,improve the inflammatory reaction of sepsis patients,and have better clinical effect.Figure0;Table14;Reference 163... |
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