全身炎症反应综合征与多器官功能障碍综合征患者外周血单核细胞COX-2与p38MAPK的关系

Relationship between COX-2 and p38MAPK of peripheral blood mononuclear cells in patients with systemic inflammatory response syndrome （SIRS） and multiple organ dysfunction syndrome （MODS）

目的了解环氧化酶-2（COX-2）与p38丝裂原活化蛋白激酶（p38MAPK）在全身炎症反应综合征（SIRS）与多器官功能障碍综合征（MODS）患者发病机制中的作用。方法选择2004年6月-2005年6月广州中山大学属第一医院EICU、SICU与急诊观察区患者符合美国胸科医师协会／危重病医学会（ACCP／SCCM）SIRS和MODS诊断标准的患者28例，其中SIRS13例，MODS15例；与患者年龄、性别相区配的健康正常对照组11例。采用淋巴细胞分离液密度梯度离心法分离外周血单个核细胞（PBMCs）。用酶联免疫测定法（EIA）检测PBMCs的COX-2与p38MAPK含量；用逆转录．聚合酶链反应（RT-PCR）法检测PBMCs中COX-2与p38MAPK的mRNA的表达。用方差分析和简单相关分析法进行统计学分析。结果MODS组患者PBMCs的COX-2与p38MAPK含量及两者的mRNA表达均显著高于正常对照组和SIRS组（P均〈0．05），正常对照组与SIRS组间差异无统计学意义；死亡患者高于存活患者（P〈0．05）；三组PBMCs中COX-2与p38MAPK含量呈正相关关系（r=0．663，P〈0．01）。死亡患者的外周血白细胞、淋巴细胞、氧合指数与存活患者比较差异无统计学意义；血糖、血肌酐则明显高于存活患者（P〈0．05）；二氧化碳总含量（TCO2）、pH明显低于存活患者（P〈0．01）。结论COX-2与p38MAPK参与了MODS的发病过程，而且可作为判断SIRS与MODS预后的参考指标之一。

Objective To study the effect of COX-2 and 008MAPK in pathogenic mechanisms in patients with SIRS and MODS. Method Form June 2004 to June 2005, 28 adult patients in SICU and EICU and observing department of emergency room in our hospital were selected, who meet the American College of Chest Physicians/Society of Critical Care Medicine criteria in 1991 for SIRS and MODS They concluded 13 SIRS patients and 15 MODS patients. The normal control group consisted of 11 healthy volunteers who matched with study subjects for age and gender. Enzyme immunoassay was used to measure the content of COX-2 and 008MAPK of PBMCs. RT-PCR was used to measure the COX-2 rnRNA and P38MAPK rnRNA expression of PBMCs. ANOVA and correlation analysis were used in statistical analysis. Results The content of COX-2 and 008MAPK of PBMCs and the mRNA expression in MODS group were higher than those in SIRS group and control group （ P 〈 0.05）. There was no significant difference between SIRS group and control group. The content of COX-2 and 008MAPK and the expression of their mRNA of PBMCs in dead patients were higher than those in survival patients （ P 〈 0.05）. In the three groups, positive correlation was indicated between the content of COX-2 and 008MAPK （ r = 0.663, P 〈 0.01）. The leukocyte, lymphocyte and oxygen compound figure （PaO2/FiO2） of peripheral blood in dead patients had not significant differentiation with surivival patients. The blood glucose and creatinine of dead patients were higher than those of survival patients （ P 〈 0.05）. The CO2 content and pH value of dead patients were lower than those of survival patients （ P 〈 0.01 ）. Conclusions COX-2 and p38MAPK take part in the onset of MODS, and they can serve as index to judge the prognosis of SIRS and MODS.