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[摘要] 目的 探讨不同病原菌感染的脓毒症患者血浆血管生成素-2（angiopoietin-2，Ang-2）水平变化及其与病情严重程度的关系。 方法 将67例脓毒症患者分为深部真菌感染组（11例）、二重感染组（G-菌合并真菌感染，36例）和革兰阴性（G-）菌感染组（20例），另选取20例健康志愿者（10男10女）为对照组。67例脓毒症患者24 h内进行急性生理和慢性健康状况（APACHEⅡ）评分、序贯器官衰竭（SOFA）评分，同时采集血标本，检测血浆Ang-2水平并与对照组比较。 结果 脓毒症各组患者的APACHEⅡ评分和SOFA评分均明显高于正常对照组（P < 0.01）；与正常对照组相比较，脓毒症各组患者的血浆Ang-2水平均显著升高（P < 0.05），而脓毒症各组患者之间的血浆Ang-2水平比较差异无统计学意义（P > 0.05）。各组患者血浆Ang-2水平与APACHEⅡ评分及SOFA评分均呈正相关（r = 0.599，P < 0.05；r = 0.723，P < 0.05）；多元线性回归分析显示Ang-2与APACHEⅡ评分及SOFA评分均呈显著独立相关（β = 0.468，P < 0.05；β = 0.626，P < 0.001）。 结论 脓毒症患者的血浆Ang-2水平显著升高，并与APACHEⅡ评分及SOFA评分均呈正相关，是影响脓毒症患者病情严重程度的独立危险因素。
[关键词] 脓毒症；血管生成素-2
[中图分类号] R631[文献标识码] A[文章编号] 1673-9701（2012）10-008-03
Plasma angiopoietin-2 levels in septic patients with different pathogen infection
CHEN Qiuping ZHANG Yuanli YAO Huaguo DENG Liehua
Department of Geriatrics, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001, China
[Abstract] Objective To investigate the plasma levels of angiopoietin-2 (Ang-2) in septic patients with different pathogen infection, and their correlations with the severity of septic patients. Methods The septic patients were divided into three subgroups which were the deep fungal infection group (n = 11), the double infection group caused by fungi and Gram-negative bacteria (n = 36) and the Gram-negative bacteria infection group (n = 20). Ten male and ten female healthy volunteers were selected for the control group. The clinical data including the acute physiology and chronic health conditions (APACHE) Ⅱ score and sequential organ failure (SOFA) score were collected and recorded. Blood samples were collected. Plasma Ang-2 was detected and statistical analyzed. Results APACHE Ⅱ score and SOFA score were significantly higher in patients of septic groups than in healthy control subjects (P< 0.01). Plasma Ang-2 levels were significantly higher in three septic groups than in healthy control group (P < 0.05). There were no significant differences of the plasma levels of Ang-2 among three septic groups (P > 0.05). The plasma Ang-2 levels and score of APACHE Ⅱ and SOFA were significant correlation (r = 0.599, P < 0.05; r = 0.723, P < 0.05, respectively). Multiple linear regression analysis showed that plasma Ang-2 levels were significantly independently correlated with the score of APACHE Ⅱ and SOFA (β = 0.468, P < 0.05; β = 0.626, P <0.001, respectively). Conclusion Ang-2 levels were increased significantly and correlated independently with score of APACHE Ⅱ and SOFA in septic patients. Ang-2 level is an independent risk factor associated with the severity of septic patients.
[Key words] Sepsis; Angiopoietin -2
脓毒症（sepsis）是具有感染证据的全身炎症反应综合征（SIRS）。脓毒症是威胁人类健康的重要疾病之一，全球每年有数百万人发病，且发病率还在增加，约1/4的脓毒症患者因抢救无效而死亡[1]。发达国家脓毒症死亡率高20%~50%[2]，我国脓毒症的死亡率更是高达40%~60%[3]。血管生成素（Angiopoietin，Ang）在炎症中的作用是近年来研究的新热点。Ang是一组分泌型内皮细胞特异性生长因子，该家族成员包括Ang-1、Ang-2、Ang-3和Ang-4，在胚胎血管发育、血管重构、炎症、癌症等方面有较深入的研究，其中Ang-2具有促炎及增加血管内皮渗透性等作用[4-6]，可能参与脓毒症、脓毒症休克的病理生理过程。本研究分析了不同病原菌感染的脓毒症患者血浆中Ang-2的水平变化以及与病情严重程度之间的关系，以期进一步探讨脓毒症新的治疗靶点。
1 资料与方法
1.1 标准
1.1.1 纳入标准2008年5月~2010年3月在我院ICU确诊为脓毒症的患者，诊断符合2001年国际脓毒症定义会议制定的脓毒症诊断标准：有2项或2项以上全身炎症反应综合征标准并有证实或推测的感染。全身炎症反应综合征（SIRS）诊断标准：包括以下2项或2项以上：①体温>38 ℃或<36 ℃；②心率>90次/min，排除患者使用降心率药物或安置起博器；③呼吸>20次/min（或PaCO2<32mm Hg）或机械通气；④白细胞计数>12 000/μL或<4 000/μL，或>10%幼稚细胞。革兰氏阴性杆菌（G-菌）感染诊断标准：痰、血或各种体液病原微生物学培养，连续分离培养出相同G-菌两次或两次以上。深部真菌感染诊断标准：符合中华医学会重症医学分会《重症患者侵袭性真菌感染诊断与治疗指南（2007）》。本研究经医院伦理委员会批准，获得患者或家属知情同意。
1.1.2 排除标准年龄大于80岁、妊娠、恶性肿瘤、慢性肾脏疾病、系统性血管炎及革兰氏阳性菌感染。
1.2 主要试剂
人血管生成素-2 ELISA试剂盒（美国R
[关键词] 脓毒症；血管生成素-2
[中图分类号] R631[文献标识码] A[文章编号] 1673-9701（2012）10-008-03
Plasma angiopoietin-2 levels in septic patients with different pathogen infection
CHEN Qiuping ZHANG Yuanli YAO Huaguo DENG Liehua
Department of Geriatrics, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001, China
[Abstract] Objective To investigate the plasma levels of angiopoietin-2 (Ang-2) in septic patients with different pathogen infection, and their correlations with the severity of septic patients. Methods The septic patients were divided into three subgroups which were the deep fungal infection group (n = 11), the double infection group caused by fungi and Gram-negative bacteria (n = 36) and the Gram-negative bacteria infection group (n = 20). Ten male and ten female healthy volunteers were selected for the control group. The clinical data including the acute physiology and chronic health conditions (APACHE) Ⅱ score and sequential organ failure (SOFA) score were collected and recorded. Blood samples were collected. Plasma Ang-2 was detected and statistical analyzed. Results APACHE Ⅱ score and SOFA score were significantly higher in patients of septic groups than in healthy control subjects (P< 0.01). Plasma Ang-2 levels were significantly higher in three septic groups than in healthy control group (P < 0.05). There were no significant differences of the plasma levels of Ang-2 among three septic groups (P > 0.05). The plasma Ang-2 levels and score of APACHE Ⅱ and SOFA were significant correlation (r = 0.599, P < 0.05; r = 0.723, P < 0.05, respectively). Multiple linear regression analysis showed that plasma Ang-2 levels were significantly independently correlated with the score of APACHE Ⅱ and SOFA (β = 0.468, P < 0.05; β = 0.626, P <0.001, respectively). Conclusion Ang-2 levels were increased significantly and correlated independently with score of APACHE Ⅱ and SOFA in septic patients. Ang-2 level is an independent risk factor associated with the severity of septic patients.
[Key words] Sepsis; Angiopoietin -2
脓毒症（sepsis）是具有感染证据的全身炎症反应综合征（SIRS）。脓毒症是威胁人类健康的重要疾病之一，全球每年有数百万人发病，且发病率还在增加，约1/4的脓毒症患者因抢救无效而死亡[1]。发达国家脓毒症死亡率高20%~50%[2]，我国脓毒症的死亡率更是高达40%~60%[3]。血管生成素（Angiopoietin，Ang）在炎症中的作用是近年来研究的新热点。Ang是一组分泌型内皮细胞特异性生长因子，该家族成员包括Ang-1、Ang-2、Ang-3和Ang-4，在胚胎血管发育、血管重构、炎症、癌症等方面有较深入的研究，其中Ang-2具有促炎及增加血管内皮渗透性等作用[4-6]，可能参与脓毒症、脓毒症休克的病理生理过程。本研究分析了不同病原菌感染的脓毒症患者血浆中Ang-2的水平变化以及与病情严重程度之间的关系，以期进一步探讨脓毒症新的治疗靶点。
1 资料与方法
1.1 标准
1.1.1 纳入标准2008年5月~2010年3月在我院ICU确诊为脓毒症的患者，诊断符合2001年国际脓毒症定义会议制定的脓毒症诊断标准：有2项或2项以上全身炎症反应综合征标准并有证实或推测的感染。全身炎症反应综合征（SIRS）诊断标准：包括以下2项或2项以上：①体温>38 ℃或<36 ℃；②心率>90次/min，排除患者使用降心率药物或安置起博器；③呼吸>20次/min（或PaCO2<32mm Hg）或机械通气；④白细胞计数>12 000/μL或<4 000/μL，或>10%幼稚细胞。革兰氏阴性杆菌（G-菌）感染诊断标准：痰、血或各种体液病原微生物学培养，连续分离培养出相同G-菌两次或两次以上。深部真菌感染诊断标准：符合中华医学会重症医学分会《重症患者侵袭性真菌感染诊断与治疗指南（2007）》。本研究经医院伦理委员会批准，获得患者或家属知情同意。
1.1.2 排除标准年龄大于80岁、妊娠、恶性肿瘤、慢性肾脏疾病、系统性血管炎及革兰氏阳性菌感染。
1.2 主要试剂
人血管生成素-2 ELISA试剂盒（美国R