细胞因子TNF-α和血管内皮细胞功能标志物与多器官功能衰竭综合征的关系(英文)

Tumor necrosis factor-αand vascular endothelial dysfunction in relation to multiple organ dysfunction syndrome

目的探讨在多器官功能衰竭综合征(MODS)患者中细胞因子TNF-α和血管内皮细胞功能标志物的变化。方法动态观察MODS及非MODS患者一氧化氮(NO)、内皮素(ET-1)、组织纤溶酶原激活物(t-Pa)、纤溶酶原激活物抑制物-1(PAI-1)、循环内皮细胞(CEC)、肿瘤坏死因子(TNF-α)的浓度,同时给予Marshall评分。结果与非MODS组相比,MODS组、死亡组的TNF-α、ET- 1、PAI-1、CEC、Marshall评分显著升高(P＜0．05),而NO、t-Pa显著降低(P＜0．05)。结论TNF-α作为炎性因子在MODS的进展中起重要作用；在MODS时内皮细胞的损伤表现为ET-1、PAI-1、CEC增加,NO、t-PA减少,Marshall评分对于危重症患者的评估是敏感指标。

Objective To study the changes of vascular endothelial functional status and cytokine TNF-α in patients with multiple organ dysfunction syndrome （MODS）. Methods Plasma levels of tissue plasminogen activator （t-Pa）, plasminogen activator inhibitor-1 （PAI-1 ）, circulating endothelial cell （CEC） and serum levels of endothelin （ET-1 ）, tumor necrosis factor- （ （TNF-α）, nitric oxide （NO） were determined serially dynamically in patients with MODS and those without MODS （non-MODS）. At the same time Marshall scores were evaluated. Results Blood levels of TNF-α, ET-1, PAI-1, CEC, and Marshall scores were significantly higher in MODS and succumbed （those who died） groups than those in non-MODS and survied （those who lived） groups （P 〈0.05）, but blood levels of NO and t-Pa were significantly lower （ P 〈 0.05）. Conclusion TNF-α played an important role in the progression of MODS. The increase of ET-1, PAI-1, CEC and the decrease of NO and t-Pa indicated endothelial dysfunction in MODS. Marshall scoring system for MODS was a sensitive parameter in evaluating the patients with MODS.