癫痫持续状态并发全身炎症反应综合征致多器官功能障碍综合征的临床研究

The Clinical Study of Status Epilepticus Leading to Systemic Inflammatory Response Syndrome Causing Multiple Organ Dysfunction Syndrome

目的探讨癫痫持续状态(SE)并发全身炎症反应综合征(SIRS)致多器官功能障碍综合征(MODS)的可能机制,揭示肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)在SE并发SIRS及向MODS转化机制中的作用及病理生理意义。方法观察78例SE患者并发SIRS及MODS的发生率;应用双抗体夹心(ELISA)法测定其血清TNF-αI、L-1β的动态变化,并与32名健康人进行对照比较。结果SE时并发SIRS的发生率为47.44%(37/78),其中56.76%(21/37)诱导发生MODS。单纯SE组、SE致SIRS组和SE致MODS组患者血清TNF-α、IL-1β水平均明显高于正常对照组(均P<0.01),并呈逐渐升高趋势,与病情的严重程度相关。结论SE并发SIRS是导致MODS的主要机制,TNF-αI、L-1β参与了SE并发SIRS及导致MODS发生、发展的病理生理过程,并具很高的预警价值。

Objective To explore the possible mechanism of status epilepticus leading to systemic inflammatory response syndrome （SIRS）, which cause the multiple organ dysfunction syndrome （MODS）. And to investigate the pathophysiological significance of serum tumor necrosis factor alpha （TNF-α） and interleukin-1β （IL-1β） in the status epilepticus complicated with SIRS and transferring to MODS. Methods To observe the complicating rate of SIRS and MODS in 78 cases of status epilepticus. The dynamic changes of serum TNF-α and IL-1β of were tested by ELISA. 32 normal healthy human were adopted as control group. Results 47.44% （37/78） of patients with status epilepticus were accompanied with SIRS, 56.76% of SIRS cases with MODS. The serum level of TNF-α and IL-1β was significantly higher in simple status epilepticus group, status epilepticus accompanied with SIRS group and status epilepticus accompanied with MODS group than that in control group （P〈0.01）. Conclusions Status epilepticus with SIRS is a main state leading to MODS. TNF-α and IL-1β may play a role in the onset and development of SIRS and MODS, and may have a predicting value to status epilepticus accompanied with MODS.