血清膽堿酯酶水平對危重癥病情判斷的意義_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

熊軍 ,  薛富善

Corresponding?author：

薛富善, Email: fruitxue@yahoo.com.cn

Keywords：

膽堿酯酶; APACHEⅡ評分; 危重癥

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目的了解危重癥患者血清膽堿酯酶( CHE) 的變化情況, 探討血清CHE 水平下降的原因及對病情嚴重程度和預后判斷的作用。方法觀察2007 年5 月至2008 年3 月入北京協和醫學院整形外科醫院ICU 病房的42 例危重癥患者。用APACHEⅡ評分系統評價病情的危重程度, 分析血清CHE 濃度變化與APACHEⅡ評分的相關性, 同時觀察患者肝功能的變化情況。結果患者血清CHE 濃度較發病前降低[ ( 187. 83 ±78. 18) U/L 比( 270. 43 ±91. 66) U/L, P lt;0. 01] , 其中23 例低于正常參考值。死亡患者CHE 濃度顯著低于存活患者[ ( 140.26 ±54. 81) U/L 比( 208. 84 ±69. 96) U/L, P lt;0. 01] 。血清CHE 水平與APACHEⅡ評分呈顯著負相關( r = - 0. 43, P lt; 0. 01) 。血清總膽汁酸( TBA) 發病前后無顯著差異。死亡組與存活組丙氨酸轉氨酶與門冬氨酸轉氨酶無顯著差異。結論 ICU 中危重癥患者血清CHE 濃度下降明顯, APACHEⅡ評分越高, CHE 下降程度越大。患者CHE 下降不是由肝實質損害引起。測定血清CHE 可作為判斷ICU 危重癥患者病情和預后的一個有意義的指標。

Citation： 熊軍,薛富善. 血清膽堿酯酶水平對危重癥病情判斷的意義. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(6): 585-587. doi: Copy

1.	陳麗峰, 吳琴. 膽堿酯酶在不同系統疾病中活性變化的觀察. 時珍國醫國藥, 2005, 16: 555-556.
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6.	王鳳學, 李樹仁, 歐陽旭紅. 血清丙氨酸氨基轉移酶和總膽汁酸聯合測定對肝病的診斷價值. 貴州醫藥, 2000, 24: 134-135.
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8.	陳方帆. 聯合測定血清TBA 肝功能酶學在肝癌肝硬化診斷中的意義. 浙江中西醫結合雜志, 1998, 8: 209-210.
9.	陳浩, 何建軍, 屠士行. 血清總膽汁酸測定在慢性肝炎與肝炎后肝硬化的臨床意義. 浙江預防醫學, 2002, 14: 13-14.
10.	Borovikova LV, Ivanova S, Zhang M, et al. Vagus nerve stimulation attenuate the systemic inflammatory response to endotoxin. Nature,2000, 405: 458-462.
11.	Bernik TR, Friedman SG, Ochani M, et al. Pharmacological stimulation of the cholinergic anti-inflammatory pathway. J Exp Med, 2002, 195: 781-788.
12.	Wang H, Yu M, Ochani M, et al. Nicotinic acetylcholine receptor α7subunit is an essential regulator of inflammation. Nature, 2003 ,421: 384-388.
13.	Hofer S, Eisenbach C, Lukic IK, et al. Pharmacologic cholinesterase inhibition improves survival in experimental sepsis. Crit Care Med,2008, 36: 404-408.
14.	Fodale V, Santamaria LB. Cholinesterase inhibitors improve survival in experimental sepsis: A new way to activate the cholinergic antiinflammatory pathway. Crit Care Med, 2008 , 36 : 622-623.
15.	Nizri E, Hamra-Amitay Y, Sicsic C, et al. Anti-inflammatory properties of cholinergic up-regulation: A new role for acetylcholinesterase inhibitors. Neuropharmacology, 2006, 50: 540-547.
16.	Reale M, Iarlori C, Gambi F, et al. The acetylcholinesterase inhibitor, Donepezil, regulates a Th2 bias in Alzheimer′s disease patients. Neuropharmacology, 2006, 50: 606-613.
17.	劉大為. 危重癥醫學. 北京: 中國協和醫科大學出版社, 2000,425.
18.	Silvestre J, Póvoa P, Coelho L, et al. Is C-reactive protein a good prognostic marker in septic patients? Intensive Care Med, 2009, 35:909-913.
19.	Gonzales R, Aaggaard EM, Camargo CA, et al. C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. J Emerg Med, doi: 10.
20.	曹衛紅, 柴家科, 孫天駿, 等. 血清膽堿酯酶在大面積燒傷患者營養狀態評價中的意義. 中國臨床營養雜志, 2006, 14: 22-25.
21.	/ j .jemermed.
22.	. 06. 021.

1. 陳麗峰, 吳琴. 膽堿酯酶在不同系統疾病中活性變化的觀察. 時珍國醫國藥, 2005, 16: 555-556.
2. 李淮安, 程愛國. 血清膽堿酯酶臨床研究進展. 中國煤炭工業醫學雜志, 2008, 11: 119-121.
3. 黃濤, 梁廷波. 肝癌患者圍手術期血清膽堿酯酶水平評估手術預后的意義. 浙江醫學, 2006, 28: 704-706.
4. 劉秀娟, 劉伯仁, 張謙, 等. 多器官功能障礙綜合征血清白蛋白及膽堿酯酶水平的意義和預后的關系. 陜西醫學雜志, 2008,37: 835-836.
5. 張寶臣, 白瑞軍. 稀釋后測定ALT、AST 值的臨床意義. 中國醫藥導刊, 2008, 10: 621.
6. 王鳳學, 李樹仁, 歐陽旭紅. 血清丙氨酸氨基轉移酶和總膽汁酸聯合測定對肝病的診斷價值. 貴州醫藥, 2000, 24: 134-135.
7. 楊秀峰, 吉建民. 血清總膽汁酸與谷丙轉氨酶測定的臨床評價.山西職工醫學院學報, 1998, 8: 4.
8. 陳方帆. 聯合測定血清TBA 肝功能酶學在肝癌肝硬化診斷中的意義. 浙江中西醫結合雜志, 1998, 8: 209-210.
9. 陳浩, 何建軍, 屠士行. 血清總膽汁酸測定在慢性肝炎與肝炎后肝硬化的臨床意義. 浙江預防醫學, 2002, 14: 13-14.
10. Borovikova LV, Ivanova S, Zhang M, et al. Vagus nerve stimulation attenuate the systemic inflammatory response to endotoxin. Nature,2000, 405: 458-462.
11. Bernik TR, Friedman SG, Ochani M, et al. Pharmacological stimulation of the cholinergic anti-inflammatory pathway. J Exp Med, 2002, 195: 781-788.
12. Wang H, Yu M, Ochani M, et al. Nicotinic acetylcholine receptor α7subunit is an essential regulator of inflammation. Nature, 2003 ,421: 384-388.
13. Hofer S, Eisenbach C, Lukic IK, et al. Pharmacologic cholinesterase inhibition improves survival in experimental sepsis. Crit Care Med,2008, 36: 404-408.
14. Fodale V, Santamaria LB. Cholinesterase inhibitors improve survival in experimental sepsis: A new way to activate the cholinergic antiinflammatory pathway. Crit Care Med, 2008 , 36 : 622-623.
15. Nizri E, Hamra-Amitay Y, Sicsic C, et al. Anti-inflammatory properties of cholinergic up-regulation: A new role for acetylcholinesterase inhibitors. Neuropharmacology, 2006, 50: 540-547.
16. Reale M, Iarlori C, Gambi F, et al. The acetylcholinesterase inhibitor, Donepezil, regulates a Th2 bias in Alzheimer′s disease patients. Neuropharmacology, 2006, 50: 606-613.
17. 劉大為. 危重癥醫學. 北京: 中國協和醫科大學出版社, 2000,425.
18. Silvestre J, Póvoa P, Coelho L, et al. Is C-reactive protein a good prognostic marker in septic patients? Intensive Care Med, 2009, 35:909-913.
19. Gonzales R, Aaggaard EM, Camargo CA, et al. C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. J Emerg Med, doi: 10.
20. 曹衛紅, 柴家科, 孫天駿, 等. 血清膽堿酯酶在大面積燒傷患者營養狀態評價中的意義. 中國臨床營養雜志, 2006, 14: 22-25.
21. / j .jemermed.
22. . 06. 021.

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