急腹症全身炎症反应综合征阶段细胞因子及炎症介质的变化

Changes of cytokines and inflammatory mediators in systemic inflammatory response syndrome in acute abdominal disease

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 :35例急腹症 SIRS患者于入院当日 (0 d)及入院后 1、 3、 7和 14 d分别采集空腹外周静脉血 ,用酶联免疫吸附法测定白细胞介素 6 (IL- 6 )及肿瘤坏死因子 α(TNF- α) ;三肽偶氮显色法测定内毒素 ;荧光分光光度法测定一氧化氮(NO)及脂质过氧化物 (L PO)。结果 :患者血浆中 IL- 6、TNF- α、内毒素水平均明显高于对照组 (P<0 .0 1) ;IL- 6和 TNF-α于入院时达峰值 ,以后逐渐下降 ,第 3天和第 7天 IL - 6明显降低 ;入院 3d内毒素持续处于高水平 ,第7天和第 14天明显下降 ;血清 L PO于入院时、第 3天和第 7天增高 (P<0 .0 1) ;NO于入院时和第 3天增高(P<0 .0 5 ) ;NO及 L PO持续处于较高水平。结论 :急腹症多见感染性 SIRS;SIRS时 IL- 6、TNF- α、NO、 L PO及内毒素增多。

Objective To determine the changes of cytokines and inflammatory mediators in systemic inflammatory response syndrome (SIRS) in acute abdominal disease. Methods The fasting peripheral venous blood were collected in 35 patients with SIRS in acute abdominal diseases on the day of admission,and 1,3,7, and 14 days after admission, respectively. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay. The level of endotoxin in plasma was determined by tripetide azo-colorimetric method,the levels of nitric oxide (NO) and lipid peroxide (LPO) in serum were examined by fluorospectro photometry. Results The levels of TNF-α, IL-6, and endotoxin in patients were obviously higher than those in control group (P<0.01); IL-6 and TNF-α levels peaked on admission, then decreased gradually. IL-6 decreased obviously on the third and seventh days; endotoxin maintained higher level within the first 3 days on admission, but obviously lowered on the seventh and fourteenth days; serum LPO levels were high on admission, the third and seventh days (P<0.01), so were the levels of NO on admission and the third day, (P<0.05); NO and LPO maintained relatively higher levels. Conclusion There is usually infectious SIRS in acute abdominal diseases; the levels IL-6, TNF-α, NO, LPO, and endotoxin are increased in SIRS.