危重症患者血清促炎性细胞因子变化的研究

The kinetic study on serum levels of pro-inflammatory cytokines in critical patients

目的 研究危重症患者血清肿瘤坏死因子 α(TNF α)、白细胞介素 6 (IL 6 )及IL 8等促炎性细胞因子的变化。方法 5 1例危重症患者进入重症监护病房 (ICU)后第 1、2、3、4、5、6及 7d清晨空腹抽取静脉血 3mL ,用放射免疫法检测血清中TNF α、IL 6及IL 8浓度。用急性生理和慢性健康评分Ⅲ (APACHEⅢ )每日进行危重症评分。每一观察日的各项指标录入数据库。结果 存活组与死亡组比较 ,TNF α从第 1个观察日起有显著性差异 (P <0 0 5 ) ;IL 8从第 4个观察日起有非常显著性差异 (P <0 0 1) ;IL 6从第 2个观察日起有显著性差异 (P <0 0 5 ) ;两组各观察日TNF α、IL 6及IL 8与各自正常值比较有非常显著性差异 (P <0 0 1) ;APACHEⅢ评分从第 1个观察日起即有非常显著性差异 (P <0 0 1)。TNF α、IL 6及IL 8与APACHEⅢ评分比较 ,敏感性、特异性、准确率、阴性预测值以及阳性预测值等基本相似。结论 TNF α、IL 6和IL

Objective To assay the serum levels of pro-inflammatory cytokines on seven consecutive days and evalute their significance as predictive and prognositc factors in critical patients.Methods 51 cases of critical patients were admitted to intensive care unit (ICU) and their periphearl blood samples were obtained on the 1 st,2 nd,3 rd,4 th,5 th,6 th,and 7 th day within the first week.The serum levels of tumor necrosis factor-α (TNF-α),interluekin-6 (IL-6) ,and interluekin-8 (IL-8) were determined by radioimmunoassay.In the meantime,the state of these patients were evaluated each day employing APACHEⅢ score system.Results The serum levels of TNF-α in dead group (group D) were significantly higher than those in survival group (group S) from the 1 st to 7 th day (P<0.05).IL-8 in group D were significantly higher than those in group S from the 4 th to 7 th(P<0.01).IL-6 in group D were significantly higher than those in group S from the 2th to 7 th day (P<0.05).However,the serum levels of TNF-α,IL-6,and IL-8 in both group S and D were significant higher than those in control group at each time point (P<0.01).The APACHEⅢ scores in group D were significantly higher than those in group S through the whole observation (P<0.01).In the terms of sensitivity,specificity,accuracy,negative and positive forecast value, serum levels of TNF-α,IL-6,and IL-8 were equivalent to APACHEⅢ scores.Conclusion Our date showed that TNF-α,IL-6 and IL-8 levels could be used to assese as disease severity and predict prognosis in critical patients which have efficacy equivalent to APACHEⅢ scores.