糖萼、肝素结合蛋白在脓毒症凝血病中的研究进展

Research progress of glycocalyx and heparin-binding protein in sepsis-induced coagulopathy

摘要:

脓毒症凝血病（sepsis-induced coagulopathy, SIC）与凝血功能异常和血管内皮损伤密切相关。糖萼是覆盖在血管内皮细胞表面的凝胶状层，由内皮细胞膜表面附着的蛋白多糖、糖胺聚糖链、糖蛋白和黏附的血浆来源蛋白组成，具有维持着血管系统的稳态，防止微血管血栓形成的作用。肝素结合蛋白是一种由中性粒细胞在炎症因子刺激下释放的颗粒蛋白，参与血管渗漏和内皮损伤。肝素因肝素结合蛋白与糖萼的结合方式以及蛋白结构和电荷的不同，可与糖萼竞争性结合肝素结合蛋白。该机制可减少内皮细胞激活和内皮损伤。表明糖萼和肝素结合蛋白均参与了脓毒症凝血病的发生发展的病理机制。结合目前相关研究，本文在此对糖萼、肝素结合蛋白在脓毒症凝血病发病机制中的作用进行综述，并探讨其在肝素抗凝中可能起到的作用。

Abstract:

Sepsis-induced coagulopathy(SIC) is closely related to coagulation dysfunction and vascular endothelial injury. Glycocalyx is a gel-like layer covering the surface of vascular endothelial cells, which is composed of proteoglycans, glycosaminoglycan chains, glycoproteins and adherent plasma-derived proteins and attached to the endothelial cell membrane. It plays a role in maintaining vascular homeostasis and preventing microvascular thrombosis. A granuloprotein released by neutrophils in response to inflammatory cytokines and involved in vascular leakage and endothelial injury. Heparin can bind heparin-binding proteins competitively with glycocalyx because of the different binding modes, structure and charge of heparin-binding proteins. This mechanism can reduce endothelial cell activation and endothelial injury. These results suggest that both glycocalyx and heparin-binding proteins are involved in the sepsis-induced coagulopathy. This article reviews the roles of glycocalyx and heparin-binding protein in the sepsis-induced coagulopathy and discusses the possible mechanism of heparin in anticoagulation therapy.