| Background:Sepsis3.0 defines sepsis as a fatal organ dysfunction caused by dysregulated host responses triggered by infection[2].Studies have shown that the global incidence of sepsis is the highest among various diseases,more than 31million annually,and its incidence is increasing[1].The high incidence,high mortality,and high medical costs of sepsis pose a serious threat to human health.The definition and diagnostic criteria for sepsis have been updated several times,which reflects the complexity of sepsis and the efforts in its diagnoseis and treatment.However,the status of sepsis diagnosis condition of sepsis in the world is still not optimistic.There are significant-variabilities in the affected population,morbidity and mortality of sepsis in different regions.Although epidedmiological information of sepsis is very important for the determination of national medical policies,medical resource allocation,and research planning,only a few relevant studies on sepsis epidemiology in china have been conducted.Up to now,there is no relevant research data about Henan Province,which is densely populated.Therefore,we in itiated sepsis epidemonligy study of Henan Province by taking advantage of the expertise of researchers in the Sepsis Laboratory of Huaihe Hospital of Henan University.In the first part of this thesis,statistical analysis of epidemiological characteristics and the status of sepsis diagnosis and treatment in Huaihe Hospital of Henan University from 2016-06 to 2018-08 are carried out.The results of this study will provid theoretical basis for prevention and control of sepsis,and guid sepsis treatment and prognosis evaluation.An important pathological change in sepsis is DIC and coagulopathy.Vitronectin?VTN?exists in plasma at a concentration of about 400mg/L,and is involved in the process of blood coagulation,But whether it participates in the pathological process of sepsis has not been reported.Our study found that plasma VTN levels in patients with sepsis were significantly lower than healthy people and patients with community-acquired pneumonia.There is a significant correlation between VTN levels in plasma and clinical parameters related to blood coagulation in patients with septic coagulopathy,suggesting that VTN may play an important role in septic coagulopathy.There are two main subtypes of VTN in plasma,and their molecular weights are different,at around 75KD and 65KD respectively.Therefore,we further analyzed the relationship between different subtypes of VTN and clinical indicators of coagulation function in sepsis patients.The results of this part of the study will help elucidate the role of VTN in the pathogenesis of sepsis and the design of treatments for sepsis.Methods:1.According to the diagnostic criteria of sepsis 3.0,154 hospitalized sepsis patients from the RICU of Huaihe Hospital of Henan University from 2016-06 to 2018-08 were identified and selected as the research subjects,and their gender,age as well as other related information were recorded."Sepsis,septicopyemia,septic shock,multiple organ dysfunction,infectious shock,systemic inflammatory response"were input as key words in"Cheng dian Medical Star Case Management System,2012"to search RICU and patients diagnosed with sepsis in the hospital from 2016-06 to 2018-08,and the number of patients admitted and died in the Department of Respiratory Medicine of Huaihe Hospital of Henan University from 2016-06 to 2018-08 was retrieved through the computer system,and the epidemiological indicators such as gender,age,sofa score,number of organ dysfunction,diagnosis rate,mortality rate,and survival rate were also analyzed.2.The plasma samples of sepsis patients who were admitted to RICU of Huaihe Hospital of Henan University from 2016-06 to 2018-08 were selected as subjects.The criteria for screening patients with septic coagulopathy are shown in Figure 5-1.Plasma samples of 17 community-acquired pneumonia patients and 19 normal healthy people were also collected.The levels of VTN and its subtypes in these specimens were measured by through Western blotting,and the correlation data were analyzed by combining with clinical data using SPSS software.Results:1.Fingings of the epidemiology study:?1?The mortality rate of patients in Huaihe Hospital of Henan University was 7‰,11‰in respiratory department,109‰in RICU,and 348‰in patients with sepsis.?2?A computer search revealed 29 patients with RICU sepsis,48.3%male and 51.7%female.According to the diagnostic criteria of sepsis 3.0,154 people were manually screened,among which 73.4%were males and 26.6%were females.The computer retrieval coverage rate was 18.83%,and the error rate was 81.17%.The computer retrieved 185 patients with sepsis in the hospital,among which 54%were males and 46%were females.After RICU computer retrieval coverage correction,the hospital had about982 patients.?3?The minimum age of patients with sepsis was 24 years old,with a maximum age of 94 years and a median of 71.?4?Patients with RICU sepsis having a score of 1-4 points account for 21.4%,5-8 points 42.8%,9-12points 25.3%,13-16 points 9.74%,and over 16 points 0.6%.10%of patients develop sepsis after admission.The vast majority of patients?90%?have more than two systemic dysfunctions,the incidence rates from high to low are:respiration,coagulation,nerve,metabolism,kidney,angiocarpy and liver,and the septic shock rate is 34%.?5?There was no significant difference in the average sofa scores of patients with RICU sepsis in Huaihe Hospital from 2016 to 2018.The survival rates were 37.5%,40.28%and 46.51%,respectively.2.The results were obtained by VTN W-B experiment and correlation analysis:?1?The levels of VTN in plasma of patients with community acquired pneumonia were not significantly different from those of normal healthy people.?2?The VTN levels in plasma samples of patients with sepsis and sepsis coagulopathy were significantly lower than those of normal healthy people and patients with community-acquired pneumonia.?3?VTN levels were significantly correlated with PTA in patients with septic coagulopathy?p<0.05??4?The levels of 75KD subtype of VTN correlated with PTA in patients with sepsis coagulopathy?p<0.05??5?The levels of 65KD subtype of VTN molecular weight 65KD subtype level had no significant correlation ship with PTA in patients with septic coagulopathy.p>0.05Conclusion:1.Epidemiological conclusions of sepsis:?1?The rate of sepsis misdiagnosis is extremely high.?2?The mortality rate of patients with RICU of the Huaihe Hospital of Henan university is higher than that of developed counties and first tier Chinese cities,but is decreasing.?3?The prognosis of sepsis is inversely correlated to age,admission conditions,sofa score,and number of dysfunctional organs.2.VTN experiment and related analysis conclusions:?1?The plasma VTN levels in patients with sepsis and sepsis coagulopathy are reduced.?2?VTN may plays an important role in clotting dysfunction in sepsis,and different subtypes may have different functions. |
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