急性脑梗死并发全身炎症反应综合征患者血清肿瘤坏死因子-α和白细胞介素-10的变化及临床意义

Changes and clinical significance of serum tumor necrosis factor-α and interleukin-10 in patients with acute cerebral infarction combined with systemic inflammatory response syndrome

目的探讨急性脑梗死(ACI)并发全身炎症反应综合征(SIRS)患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)水平变化及其与多脏器功能障碍综合征(MODS)和病死率的关系。方法104例ACI患者根据是否并发SIRS分为non-SIRS组(65例)和SIRS组(39例),分别于发病24h内及3d、7d、14d晨起空腹抽取静脉血3mL,采用放射免疫法(RIA)测定血清TNF-α、IL-10水平,并观察2组患者的MODS发生率和病死率。结果non-SIRS组发病24h、3d、7d、14d不同时间血清TNF-α比较无显著差异(P=0.193),SIRS组有显著差异(P=0.032);SIRS组血清TNF-α水平明显高于non-SIRS组(P=0.000),各时间点SIRS组血清TNF-α水平明显高于non-SIRS组(P=0.000)。non-SIRS组和SIRS组发病24h、3d、7d、14d不同时间血清IL-10比较均有显著差异(P=0.000),2组在3d时IL-10达到高峰,以后随着时间而逐渐下降;SIRS组血清IL-10水平明显高于non-SIRS组(P=0.009),SIRS组发病24h、3d、7d时血清IL-10明显高于non-SIRS组,14d时2组无显著差异(P=0.095)。SIRS组MODS发生率明显高于non-SIRS组(P=0.025),SIRS组病死率明显高于non-SIRS组(P=0.005)。结论TNF-α及IL-10参与了脑梗死患者SIRS的发生、发展过程,TNF-α和IL-10可作为预测MODS的早期指标。

Objective To observe the changes of serum tumor necrosis factor-α （TNF-α） and interleukin-10 （IL-10） in patients with acute cerebral infarction（ACI） combined with systemic inflammatory response syndrome （SIRS）, and to study the relationship to multiorgan dysfunction syndrome （MODS） and death rates. Methods One hundred and four patients with ACI were divided into SIRS （39 cases） and non-SIRS （65 cases） group. 3 mL venous blood were took on empty stomach at morbidity 24 h,3 d,7 d and 14 d to determine serum TNF-α and IL-10 by radioimmunoassay, and incidence rates of MODS and death rates were observeed in two groups. Results There was no significant difference in serum TNF-α at morbidity 24 h,3 d,7 d and 14 d in no-SIRS group （P = 0. 193 ）, but there was significant difference in SIRS group （P = 0.032）. The serum TNF-α was higher obviously in SIRS group than this in non-SIRS group at different time （P = 0. 000）. There was significant difference in serum IL-10 at different time in two groups（ P = 0. 000）. The serum IL-10 was higher obviously in SIRS group than this in non-SIRS group（ P =0. 009） ,it was higher in SIRS group than this in non-SIRS group at morbidity 24 h,3 d and 7 d,but there was no significant difference between two groups at 14 d（P = 0. 095 ）. The incidence rates of MODS and death were higher obviously in SIRS group than this in non-SIRS group（P = 0.025 ,P = 0. 005 ）. Conclusion TNF-α and IL-10 participate in the occurrence and development of SIRS after cerebral infarction. They can be regarded as prophase index of predicting MODS.