心肺复苏后全身炎症反应综合征患者血清细胞因子动态变化及意义

Dynamic changes and significance of serum cytoldnes in patients with systemic inflammatory response syndrome after successful cardiopulmonary resuscitation

目的探讨细胞因子在心肺复苏（CPR）后全身炎症反应综合征（SIRS）病理生理中作用及意义。方法用ELISA法检测21例CPR自主循环恢复（ROSC）者血清TNF-α、IL-1β、IL-4、IL-8、IL-10含量，按SIRS标准分为SIRS组和非SIRS组，比较2组差异。结果2组CPR时血清细胞因子差异无统计学意义（P〉0．05），SIRS组ROSC24h TNF-α、IL-1β、IL-8高于其CPR时和非SIRS组（P〈0.05-0．01），gOSC48h IL-4、IL-10增高，细胞因子均达峰值并高于非SIRS组（P〈0.05-0．01），ROSC7dTNF-α、IL-1β、IL-8下降，IL4、IL-10仍较高水平。结论细胞因子参与复苏后SIRS发病过程，选择时机干预其失衡，提高复苏存活率。

Objective To investigate the clinical significance of serum cytokines in the pathogenesis of patients with systemic in- flammatory response syndrome （SIRS） after successful cardiopulmonary resuscitation （CPR）. Methods The patients undergone CPR were divided into SIRS group and no SIRS group. The levels of serum tumor necrosis factor-α （ TNF-α）, interleukin-1β （ IL-1β）, interleukin-4 （IL-4）, interleukin-8 （IL-8）, interleukin-10 （IL-10） were measured in 21 patients after CPR with return of spontaneous circulation （ROSC） by enzyme-linked immunosorbent assay （ELISA）. Results There was no significant difference of serum cytokines between the two groups at cardiac arrest-before CPR （ P 〉 0. 05）. In SIRS group, the levels of serum TNF-α, IL-1β, IL-8 were increased and significantly higher than those in no SIRS group after ROSC 24h （ P 〈 0.05 - 0. 01. The levels of serum IL-4, IL-10 were increased and higher than those in no SIRS group, also the peak levels of serum cytokines were reached after ROSC 48h （ P 〈0. 05 -0. 01 ）. The serum TNF-α, IL- 1β, IL-8 were decreased, but the serum IL-4, IL-10 were kept at a high level after ROSC 7 days. Conclusions The serum cytokines play an important role in the pathogenesis of SIRS after CPR. To intervene and maintain the balance of cytokines may be a way to improve the patient＇s prognosis after CPR.