标题：脓毒症患者内源性硫化氢水平变化及其与凝血功能的关系

      作者：陈阳，张志坚，董瑶瑶，李丹，黄云帆，彭礼波    重庆市巴南区人民医院重症医学科，重庆 401320

      卷次： 2019年30卷23期

      【摘要】 目的 探讨脓毒症(sepsis)患者内源性硫化氢(H2S)水平的变化及其与凝血功能的关系。方法 选取2017年7月至2018年6月重庆市巴南区人民医院收治的35例脓毒症患者(脓毒症组)和35例脓毒性休克(脓毒性休克组)患者作为研究对象，选择同期健康体检者35例作为对照组。留取三组受检者空腹静脉血，测定血浆H2S、凝血因子Ⅷ (FⅧ)、纤溶酶原(PLG)、抗凝血酶(AT)、组织因子(TF)、血小板计数(PLT)、肿瘤坏死因子-α (TNF-α)含量，并对H2S与凝血功能各指标行相关性分析。结果 与对照组比较，脓毒症组、脓毒性休克组患者血浆H2S、FⅧ、TF及TNF-α表达均显著升高，血浆PLG、AT活性显著降低，血小板计数显著下降，且脓毒性休克组各指标升高或降低较脓毒症组更明显，差异均具有统计学意义(P<0.05)。H2S与TF、FⅧ、TNF-α正相关(r=0.70、0.54、0.64，P<0.05)，与PLG、AT负相关(r=-0.71、-0.55，P<0.05)。结论 脓毒症患者内源性H2S可能通过上调TF、TNF-α来介导凝血功能障碍。
      【关键词】 脓毒症；硫化氢；凝血功能；肿瘤坏死因子-α；组织因子
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2019）23—2993—04

Change in endogeous hydrogen sulfide in patients with sepsis and its relationship with coagulation function.CHEN Yang, ZHANG Zhi-jian, DONG Yao-yao, LI Dan, HUANG Yun-fan, PENG Li-bo.
Department of Crite CareMedicine, People's Hospital of Ba'nan District of Chongqing, Chongqing 401320, CHINA
【Abstract】 Objective To study the change in endogenous hydrogen sulfide (H2S) in patients with sepsis and itsrelationship with coagulation function. Methods Thirty-five patients with sepsis (sepsis group) and thirty-five pa-tients with septic shock (septic shock group) admitted to People's Hospital of Ba’nan District of Chongqing from Ju-ly 2017 to June 2018 were enrolled. Thirty-five healthy persons served as control (control group). Blood was collect-ed to determine the levels of H2S, blood coagulation factorⅧ (FⅧ), plasminogen (PLG), antithrombin (AT), plateletcount (PLT), tissue factor (TF), tumor necrosis factor-α (TNF-α). The correlations among the above parameterswere analyzed. Results Compared with control group, the levels of H2S, FⅧ, TF, and TNF-α in sepsis group and sep-tic shock groups were significantly elevated (all P<0.05), the PLG, AT activity, and platelet count were significantly de-creased (all P<0.05). The changes in the parameters in septic shock group were more remarkable than those in sepsisgroup (all P<0.05). H2S was positively correlated with TF, FⅧ, and TNF-α (r value was 0.70, 0.54, 0.64, all P<0.05),and it was negatively correlated with PLG and AT (r value was -0.71, -0.55, both P<0.05). Conclusion As an inflam-matory factor, endogenous H2S deteriorates coagulation function in patients with sepsis by up-regulating TF and TNF-α.
      【Key words】 Sepsis; Hydrogen sulfide; Coagulation function; Tumor necrosis factor-α; Tissue factor