严重多发伤患者外周血清对巨噬细胞核因子-KB的激活作用及其与预后的关系

Stimulating effect of sera from severe trauma patients on NF-KB activity in macrophage and its relationship with patients prognosis

目的探讨严重多发伤患者伤后24h外周血清对巨噬细胞核因子-KB（NF—KB）的激活作用及其与预后的关系。方法收集47例严重多发伤患者及24名健康体检者的外周血清。将带有荧光素酶报告基因的NF—KB重组质粒转染至巨噬细胞（RAW264．7），24h后用不同的血清刺激该细胞6h。检测荧光素酶活性以反映血清对NF．KB的激活作用强度，同时以ELISA法测定血清中白细胞介素-1β（IL-1β）、肿瘤坏死因子α（（TNF—α）、白细胞介素-10（IL-10）、白细胞介素-1（IL-1）受体拮抗剂（IL-1Ra）、可溶性肿瘤坏死因子受体I（sTNFRI）水平。结果创伤血清组对巨噬细胞NF—KB的激活作用显著高于正常血清组，且创伤后MODS组、死亡组值分别显著高于无MODS组及存活组。该变化与APACHEⅡ评分呈明显的正相关，但与血清中各细胞因子水平无明显相关性。NF—KB活性在判定MODS及死亡结局的受试者作业特征曲线（ROC）下面积显著大于APACHEⅡ评分的ROC下面积。结论早期测定严重多发伤患者外周血清对巨噬细胞NF—KB的激活作用对MODS及死亡结局的判定具有参考价值。

Objective To investigate the stimulating effect of sera from severe multiple trauma patients within 24 h post trauma on nuclear factor-KB（NF-KB） activity in macrophage and their relationship with patients prognosis. Methods Peripheral blood of 47 patients with multiple traumas with injury severity score（ISS） ≥ 16 and 24 healthy volunteers were obtained, and sera samples were isolated. And 24 h after transfection of the recombinant NF-KB plasmid containing luciferase reporter gene into the mouse macrophage line （ RAW 264. 7 ） , the cells were stimulated by sera from different patients for 6 h, then stimulating effect of sera on NF-KB was assessed by luciferase activity. The concentrations of interleukin-1β, tumor necrosis factor α, interleukin-10, interleukin-1 receptor antagonist, and soluble tumor necrosis factor receptor I were detected with ELISA kits. Results The stimulating activity of sera from trauma patients on NF-KB was increased significantly, and it was higher in MODS group, nonsurvivor group than that in non-MODS, survivor group respectively. The level of activity was correlated positively with APACHE Ⅱ score, while it did not have relationship to the cytokine or endogenous antagonist levels. The area under the receiver operating characteristic curve （ROC）of NF-KB activity for predicting MODS and mortality was significantly higher than that of APACHE Ⅱ score. Conclusion Early measurement of NF-KB stimulating activity of sera from severe multiple trauma patients may have the value to predict occurrence of MODS and mortality.