乌司他丁对重度急性有机磷农药中毒患者细胞因子影响的研究

Study of the Influence of Ulinastatin Intervention on Cytokines in Patients with Severe Acute Organophosphorous Pesticide Poisoning

目的探讨乌司他丁干预对重度急性有机磷农药中毒(AOPP)引发多器官功能障碍综合征(MODS)患者血清 TNFα、IL-6及 IL-10水平动态变化的影响。方法重度 AOPP 引发 MODS 患者46例,临床随机分为常规治疗组(n=24)、乌司他丁干预组(n=22),同步检测两组患者血清中上述细胞因子的动态变化,并与健康对照组(n=20)进行对比分析。结果常规治疗组与乌司他丁干预组患者血清中 TNF-α、IL-6及 IL-10水平均高于健康对照组(P<0.01);两组治疗前后比较,血清 TNF-α、IL-6及 IL-10水平均有明显降低(P<0.01),但乌司他丁干预组血清 TNF-α、IL-6的降低水平较常规治疗组更明显(P<0.01),而治疗后血清 IL-10水平两组比较无显著性差异(P>0.05)。乌司他丁干预组的病死率明显低于常规治疗组(P<0.05),痊愈患者的住院时间也明显缩短(P<0.01)。结论 TNF-α、IL-6及 IL-10等细胞因子参与重度 AOPP 引发 MODS 患者的病理过程;乌司他丁干预能明显降低重度 AOPP 患者血清 TNF-α、IL-6水平,从而降低并发 MODS 的重度 AOPP 患者的病死率。

Objective To investigate the influence of ulinastatin intervention on the dynamic variation of interleukin- 6, interleukin-10 and Tumor necrotic factor-α in patients with multiple organ dysfunction syndrome caused by severe acute organophosphorus pesticide poisoning（AOPP）. Methods 46 patients with MODS casued by severe AOPP were randomly and clinically divided into conventional group（24 patients） and ulinastatin intervention group（22 patients）. The dynamic variations of these cytokines were detected synchronizingly and compared with healthy control group（20 patients）. Results The levels of IL-6,IL-10 and TNF-α in serum of both of conventional therapy group and ulinastatin intervention group were higher than healty control group（ P 〈0. 01 ） and decreased obviously after therapy（ P 〈0. 01 ）. The contents of IL-6 and TNF-α of ulinastatin intervention group after therapy had a greater decrease than conventional therapy group （ P 〈 0. 01 ） ,but there was no significant difference when compared with IL-10（ P 〉0. 05 ）. The case fatality of ulinastatin intervention group was lower obviously than conventional therapy group, and the length of stay in hospital was also shorter. Conclusion TNF-α, IL-6 and IL-10 have effects on the pathological process of MODS caused by severe AOPP. Ulinastatin can obviously decrease the levels of TNF-α and IL-6, which conduce to the decrease of case fatality of severe AOPP patients with MODS.