多器官功能障碍综合征患儿血清促炎因子/抗炎因子动态变化及其临床意义

The Dynamic change of circulating proinflammatory/anti-inflammatory factors levels in children with MODS

目的动态监测多器官功能障碍综合征(MODS)患儿促炎因子/抗炎因子变化及其临床意义。方法采用Luminex液相分析平台,对72例MODS患儿第1、3、7天3个时点的血清促炎(IL-1β、IL-2、IL-6、IL-8、TNFα-)及抗炎因子(IL-4、IL-10、GM-CSF)水平进行测定,并设立50例健康体检儿为正常对照组。采用SPSS 11.0进行统计分析。结果与对照组比较,MODS组第1天血清IL-6、IL-8、IL-10均显著升高(P<0.05),且为3个时点中最高点;IL-2、TNFα-则3个时点均显著下降(P<0.05),第3天为最低点;GM-CSF第7天最高(P<0.05);IL-1β、IL-4无显著波动(P>0.05)。MODS存活的患儿IL-6、IL-8、IL-10在第1天呈显著升高,第3、7天却显著下降(P<0.05);GM-CSF则在第7天较前两个时点显著升高(P<0.05);而恶化的患儿上述4个细胞因子3个时点均呈高水平状态,各时点间差异均无显著性(P>0.05)。结论MODS形成初始阶段已存在强烈的促炎与抗炎反应,且促炎/抗炎系统已失衡;动态监测MODS的血清IL-6、IL-8、IL-10、GM-CSF等炎症因子的变化趋势可为临床判断预后提供参考价值,前三者如持续升高,提示预后不良,而GM-CSF在病程后期逐渐升高,提示病情趋于好转。

Objective To monitor the change of circulating proinflammatory/anti-inflammatory factors levels in children with MODS and evaluating its clinical value. Methods Seventy-two children with MODS and 50 healthy children as control were enrolled in this study. Proinflammtory factors（ IL-Iβ, IL-2, IL-6, IL-8, TNF-α） and anti-inflammatory factors （IL-4, IL-10,GM-CSF） levels in serum were detected by Luminex liq- uid phase analysis system on day 1, 3, 7 respectively. All data were analyzed statistically in SPSS 11.0 soft- ware. Results Compared with control group, the IL-6, IL-8, IL-10 levels in MODS group increased signifi- cantly on day 1 （P （0.05）, Which were the highest in the three time points; IL-2, TNF-adecreased signifi- candy in the three time points（ P （0.05） and were the lowest on day 3 ; GM-CSF came to the highest on day 7（P（0.05）;IL-1β, IL-4 had no obvious fluctuation （P 〉0.05）. MODS＇s group was divided into survival and non-survival groups. In survival group, statistical analysis showed that IL-6, IL-8, IL-10 increased signifi- candy on day 1, but decreased greatly on day 3, 7 （ P 〈 0.05） ; GM-CSF increased significantly on day 7 com- pared with other two time points （P 〈0.05）. However, above-mentioned four factors were at high level at all the three time points in non-survival group and there were no statistical difference between any two time points （ P 〉 0.05）. Conclusion All data in this study show that there are powerful inflammatory and anti-inflamma- tory responses during early period of MODS pathogenesis, and inflammatory/anti-inflammatory system is un- balanced. It suggested bad prognosis if the three former factors （IL-6, IL-8, IL-10） remain on high levels, but good prognosis if GM-CSF level gradually increase in late stage of MODS.