严重创伤患者血浆TNF、IL-6、IL-8和内毒素的变化

Kinetics of Plasma TNF,IL 6,IL 8 and Endotoxin Levels in Patients with Severe Trauma and their Relationship

本研究选择１７例严重创伤患者，根据ＩＳＳ计分将患者分为两组（即ＩＳＳ１６－２５（Ⅰ组）和ＩＳＳ＞２５组（Ⅱ组）），动态观察伤后两周内血浆ＴＮＦ、ＩＬ－６和ＩＬ－８及内毒素水平的变化，并分析其相关性。研究结果显示，创伤后，患者血浆细胞因子水平可相继明显升高，其中血浆ＴＮＦ水平升高较早，血浆ＩＬ－６、ＩＬ－８较晚，Ⅱ组血浆细胞因子水平明显高于Ⅰ组，且三种血浆细胞因子均值分别与ＩＳＳ计分呈显著正相关。血浆内毒素水平在创伤早期也明显升高，其均值分别与ＩＳＳ计分和血浆细胞因子水平也呈显著正相关。研究结果提示，严重创伤能引起明显的细胞因子反应及内毒素血症，创伤后早期内毒素大量侵入可能是创伤后细胞因子产生、释放增加的重要机制之一。

This experiment was designed to investigate the kinetics of plasma tumor necrosis factor (TNF),interleukin 6(IL 6),interleukin 8(IL 8) and endotoxin levels,and their correlation in 17 cases of patients subjected to severe trauma,which were divided into two groups (ISS 16 25(group Ⅰ)and ISS>25(group Ⅱ)groups respectively)according to Injury Severity Score(ISS).It was found that plasma cytokine levels in trauma patients could successively significantly increased.Plasma TNF was shown to be increased earlier,while increases in plasma IL 6 and IL 8 levels occurred later.Plasma cytokines in group Ⅱ were shown to be significnatly higher than those in group Ⅰ,which were significantly correlated with ISS.Plasma endotoxin levels were also shown to be markedly elevated at the early stage of trauma,the means of which were correlated with ISS and plasma cytokine levels.The results suggest that severe trauma could induce marked cytokine responses and endotoxemia.Endotoxin translocatin into body at the early stage of trauma might be one of important mechanisms to induce overproduction of cytokines after trauma.