Expression And Clinical Significance Of Vascular Endothelial Glycocalyx In Patients With ICU Sepsis

Objective:To investigate the expression and clinical significance of vascular endothelial glycocalyx in patients with septic shock.Methods:The 35 patients with septic shock admitted to the Department of Critical Care Medicine,the Fourth Affiliated Hospital of Kunming Medical University from December 2017 to November 2018 were divided into the survival group(24 cases)and the death group according to the final clinical outcome of sepsis patients.(11 cases),10 cases in the control group.The main components of vascular endothelial glycosides in serum at different time(0h,6h,12h,24h,48h)after septic shock were detected by ELISA:syndecan-1 and heparan sulfate(Heparan)Sulphate)and inflammatory factor high mobility group protein B1(HMGB1)expression levels;sequential organ failure(SOFA)scores recorded at Oh and 48h,procalcitonin(PCT),blood routine(WBC),blood lactate(Lac),liver and kidney function(ALT,Cre),myocardial enzymology(CTnT)and other values to assess the severity of illness and organ damage in patients with sepsis.One-way ANOVA was used for comparison between groups and groups in each experimental group.Two independent samples were analyzed by t test.The correlation analysis of each index was performed by Pearson method.The difference was statistically significant at P<0.05.A receiver operating characteristic(ROC)curve was drawn to assess the value of vascular endothelial glycocalyx and HMGB1 in prognosis assessment in patients with sepsis.Results:(1)A total of 35 patients with sepsis who met the diagnostic criteria for sepsis included in this study included 24 patients in the survival group and 11 patients in the death group.The mortality rate was 31.4%.The age group and gender composition of the two groups were Quite,the difference between the groups was not statistically significant(P>0.05);(2)SOFA score and organ function in patients with sepsis:compared with the control group,①index of the Oh sepsis group increased significantly,including SOFA score,WBC,PCT,Lac,ALT,Cre and cTnT.Statistically significant(P<0.05);②in the 48h sepsis group,the indicators were compared with the Oh group,and the SOFA scores,PCT,Lac,ALT,Cre,and cTnT were statistically significant(P average<0.05),and the WBC difference was not statistically significant(P>0.05).(3)The expression changes of SDC-1,HS and HMGB1 in septic shock patients at each time point:①compared with the control group,HMGB1 and HS and SDC-1 in septic shock patients were Oh;6h into the room,12 in the room,48h into the room They were significantly higher than the control group,and the difference was statistically significant(P<0.05).② In patients with septic shock,compared with the Oh group,septic shock HMGB1,HS and SDC-1 entered the room for 6h,12h,24h,48h,the higher than the septic shock into the Oh group,the difference was statistically significant(P<0.05)③in the septic shock into the Oh group survival group compared with the death group:survival group SDC-1,HS and HMGB1,low In the death group,the difference was statistically significant(P<0.05).④ In the 48h group of septic shock,the survival group was compared with the death group:the survival group SDC-1,HS and HMGB1 were lower than the death group,the difference was statistically significant(P<0.05).(4)Prognostic efficacy of SDC-1 and HS and HMGB1 in patients with septic shock:① At 0 h after admission,SDC-1(AUC 0.868,95%CI 0.509-0.927),HS(AUC 0.719,95%CI 0.439)The sensitivity and specificity of-0.823)and HMGBI(AUC 0.839,95%CI 0.632-0.975)were 82.10%and 85.33%,69.51%and 76.38%,and 89.32%and 79.09%,respectively;②at 48 h after entering,SDC-The sensitivity and specificity of 1(AUC 0.831,95%CI 0.773-0.921),HS(AUC 0.794,95%CI 0.774-0.972)and HMGB1(AUC 0.869,95%CI 0.791-0.948)were 87.53%and 81.32,respectively.%,75.39%and 93.28%and 95.32%and 89.63%,the difference was statistically significant(P<0.05).(5)Correlation between SDC-1,HS and HMGB1 and SOFA scores and clinical indicators:SDC-1,HS and HMGB1 were negatively correlated with SOFA scores,and the correlation index was r<0,which was statistically significant(P<0.05).-1,HS and HMGB1 were positively correlated with PCT,Lac,ALT,Cre,cTnT,and the correlation index was r>0,which was statistically significant(P<0.05).Conclusion:1.The more severe the inflammatory response in patients with septic shock,the more degradation of endothelium.2.The expression of vascular endothelial glycocalyx and inflammatory factor HMGB1 in septic shock patients is associated with organ function damage.3.Combined with the changes of lactic acid and lactic acid clearance rate and organ function damage,the expression of vascular endothelial glycoside degradation products has a reference value in predicting the prognosis of patients with septic shock.