摘要
目的 :探讨急腹症全身炎症反应综合征 (SIRS)阶段细胞因子及炎症介质的变化特点。方法 :动态检测 43例 SIRS患者血白介素 6 (IL 6 )、肿瘤坏死因子 α(TNFα)、内毒素、一氧化氮 (NO)及脂质过氧化物(L PO)。结果 :患者血浆 IL 6、TNFα和内毒素于入院时及入院第 3和 7日增高 (P均 <0 .0 1) ;IL 6和TNFα于入院时达峰值 ,以后逐渐下降 ,第 3和 7日 IL 6明显降低 ;入院 3日内毒素持续于高水平 ,第 7和14日明显下降 ;血清 L PO 于入院时、第 3和 7日增高 (P均 <0 .0 1) ;NO于入院时和第 3日增高(P均 <0 .0 5 ) ;NO及 L PO持续于较高水平。入院时 TNFα与体温、第 3日 IL 6与 L PO及 TNFα与 NO均呈正相关 (r1 =0 .740 ,P=0 .0 0 2 ;r2 =0 .5 19,P =0 .0 39;r3=0 .5 90 ,P =0 .0 43)。结论 :急腹症多见感染性SIRS;SIRS时 IL 6、TNFα、NO、L PO、内毒素增多。血浆 IL 6含量高于 2 5 0 ng/ L可诊断为 SIRS,敏感性和特异性各为 95 %和 10 0 % ;IL 6高于 30 0 ng/ L 约 1周提示发展为多脏器功能障碍综合征 (MODS)
Objective:To determine the changes in some cytokines and some other inflammatory mediators during systemic inflammatory response syndrome(SIRS) in acute abdominal diseases.Methods:A prospective clinical study was performed on 43 patients.Among them,the patients who received Chinese herb medicine served as group A,and the others who were not treated with Chinese herbs served as group B.Another 12 healthly individuals served as normal control (group C).Plasma interleukin6(IL6),tumor necrosis factorα (TNFα),endotoxin,serum nitric oxide(NO) and lipid peroxide(LPO) were examined dynamically.Results:IL6,TNFα and endotoxin levels in group B were higher than that in group C on day 0,3,7 (all P <0 01);IL6 and TNFα levels peaked at day 0,then decreased gradually,IL6 decreased significantly on day 3,7;endotoxin maintained higher level within first 3 days,but was obviously lowered at day 7,14.LPO level in group B was higher than that in group C on day 0,3,7 (all P <0 01),so was NO on day 0,3 (all P <0 05);NO and LPO maintained relatively higher levels within first 1 week and 2 week respectively,then reduced slowly.TNFα in group A correlated positively with body temperature on day 0 ( r =0 740, P =0 002);IL6 correlated positively with LPO on day 3( r =0 519, P =0 039);NO correlated positively with TNFα on day 3( r =0 590, P =0 043).Conclusions:There is usually infectious SIRS in acute abdominal diseases;IL6,TNFα,NO,LPO and endotoxin levels elevate significantly during SIRS.IL6 content in plasma greater than 250 ng/L may be diagnosed as SIRS,and the sensitivity and specificity are 95% and 100% respectively;IL6 greater than 300 ng/L for 1 week or so suggests that SIRS has developed to or is developing to multiple organ dysfunction syndrome(MODS).
出处
《中国危重病急救医学》
CAS
CSCD
2001年第9期542-544,共3页
Chinese Critical Care Medicine
基金
天津市科委"九.五"重点课题资助项目(No.983 113 4 11)
