蝮蛇伤患者外周血肿瘤坏死因子-α白细胞介素-6的变化及临床意义

Expressions of peripheral serum TNF -α and IL - 6 in the patients bitten by Agkistrodon halys and the clinical significance

目的检测蝮蛇伤患者外周血清肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）的表达，探讨其临床意义。方法80例蝮蛇伤患者按照入院时的病情严重程度分为轻型、重型、危重型；根据多器官功能障碍综合征（MODS）诊断标准分为MODS组和非MODS组；根据抗蝮蛇毒血清干预的时间分为干预前组、干预后6h组、干预后24h组。所有患者均于人院后未做任何处理前和注射抗蝮蛇毒血清后6、24h三个时相点采血收集标本，采用ELISA法检测外周血清TNF-α和IL-6并分析。选取同期30例健康人群为对照组。结果蝮蛇伤患者血清TNF-α和IL-6水平均为危重型最高，对照组最低，且对照组、轻型组、重型组、危重型组两两比较差异均有统计学意义（P〈0．01）；MODS组与非MODS组比较差异均有统计学意义（P〈0．01）；干预前组、干预后6h组、干预后24h组两两比较差异均有统计学意义（P〈0．01）。结论蝮蛇伤患者病情越重，其血清TNF-α、IL-6水平越高；蝮蛇伤患者并发MODS与TNF-α和IL-6密切相关；抗蝮蛇毒血清可以通过中和游离毒素，避免炎症进一步加重。

Objective To detect the expressions of serum TNF-α and IL - 6 in the patients bitten by Agkistrodon halys, and to investigate their clinical significance. Methods The studies included 80 cases of patients bitten by Agkistrodon halys as experimental group and 30 cases of normal adults as control group. According to severity degrees on admission, patients bitten by Agkistrodon halys were divided into three types： mild, severe and critical type, respectively. According to MODS diagnostic criteria, the patients were divided into two groups ： MODS group and non - MODS groups, respectively. In accordance with the time of using anti - Agkistrodon venom serum, all the patients were divided into pre - intervention, 6 hours after the intervention, 24 hours after the intervention groups. The expression of serum TNF -α and IL - 6 of all the patients on admission without any intervention was assessed by enzyme - linked immunosorbent assay, while we detected the expressions of TNF -α and IL- 6 at 6 hours after giving anti - Agkistrodon venom serum, 24 hours after the intervention, respectively. Results Serum TNF -α and IL - 6 level were the highest in critical group, the lowest in control group. Among the control group, mild group, severe group and critical group, the expression of serum TNF -α and IL - 6 between any two groups had statistical significance （ P 〈 0. 01 ）. There was statistical difference in serum TNF -α, IL - 6 levels between MODS group and non - MODS group （ P 〈 0. 01 ）. Among the pre -intervention group, 6 h after the intervention group and 24 h after the intervention group, the differences between any two groups were statistically significant （P 〈 0. 01 ）. Conclusion The more severe conditions of the patients bitten by Agkistrodon halys are, the higher serum TNF -α and IL - 6 levels are. Expressions of serum TNF -α and IL - 6 of the patients bitten by Agkistrodon halys are closely related with the occurrence of MODS. Anti - Agkistrodon venom serum can reduce the inflammatory response by inhibiting two cytokines.