蜂螫伤中毒患者血清细胞因子的变化

Changes and clinical significance of serum cytokines in patients with bee-sting poisoning

目的探讨蜂螫伤中毒患者血清粒细胞-单核巨噬细胞集落刺激因子(GM-CSF)、肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)的变化及临床意义。方法将109例蜂螫伤中毒患者分成轻度、中度、重度中毒三组,并根据预后分成死亡组、非死亡组。另选取35名健康人作为正常对照组,采用放射免疫法检测血清GM-CSF和TNF-α水平,酶联免疫吸附法检测血清IL-6、IL-8水平,同时比较各组间的差异。结果蜂螫伤轻度中毒组患者血清GM-CSF、TNF-α、IL-6、IL-8水平仅轻度升高,与正常对照组比较差异无显著性(P＞0．05),中度中毒组和重度中毒患者血清GM-CSF、TNF-α、IL-6、IL-8水平较正常对照组明显升高(P＜0．01),中度中毒组患者血清GM-CSF、TNF-α、IL-6、IL-8水平较轻度中毒组明显升高(P＜0．01),重度中毒组患者血清GM-CSF、TNF-α、IL-6、IL-8水平较中度中毒组明显升高(P＜0．01)。死亡组血清GM-CSF、TNF-α、IL-6、IL-8水平明显高于非死亡组(P＜0．01)。APACHEⅡ评分与血清GM-CSF、TNF-α、IL-6、IL-8水平呈显著正相关(P＜0．05或P＜0．01)。结论血清GM-CSF、TNF-α、IL-6、IL-8R可能协同参与了蜂螫伤中毒患者病情的发生、发展过程。动态观测血清GM-CSF、TNF-α、IL-6、IL-8水平与APACHEⅡ评分对于判断蜂螫伤中毒患者病情轻重与估计预后可能有一定的临床价值。应用细胞因子拮抗剂或抑制剂对防治蜂螫伤中毒患者的发生发展、降低病死率可能有重要的临床意义。

Objective To investigate changes and clinical significance of serum granulocyte-macrophage colony stimulating factor （GM-CSF）, tumor necrosis factor-alpha （TNF-α）, interleukin-6 （IL-6） and interleukin-8 （IL-8） level in patients with bee- sting poisoning. Methods One hundred and nine patients with bee-sting poisoning were also divided into slight poisoning group, moderate poisoning group, and server poisoning group and also divided into dead group and survival group according to the prognosis. Thirty healthy persons were selected as control group. GM-CSF and TNF-α were measured using radioimmunoassay, IL-6 and IL-8 was measured using enzyme linked immunoadsorbent assay （ELISA）, and they were compared with control grouup. Results The levels of serum GM-CSF, TNF-α, IL-6, IL-8 in slight poisoning group were increased a little, and there were no significant difference compared with control group （ P 〉 0.05）. The levels of serum GM-CSF, TNF-α, IL-6 and IL-8 were significanfly higher in moderate poisoning group and severe poisoning group than those in the control group （P 〈 0.01）, but the severe poisoning group were much higher than the moderate poisoning group （ P 〈 0.01 ） . They were significantly higher in survival group than those in dead group （ P 〈 0.01 ）. APACHE Ⅱ scores were obvious correlated with the levels of serum GM-CSF, TNF-α, IL-6 and IL-8 （P 〈 0.05 or P 〈 0.01 ）. Conclusion GM-CSF, TNF-α, IL-6 and IL-8 may participate in the occurrence and progress of patients with bee-sting poisoning. Dynamic monitoring of serum GM-CSF, TNF-α, IL-6 , IL-8 and APACHEⅡ scores plays an important role in diagnosis of the severity of patients with bee-sting poisoning and its prognosis. The use of antagonist and inhibitor of cytokines may be helpful to treat patients with bee-sting poisoning.