乌司他丁对腹蛇咬伤患儿血清细胞因子水平的影响

Effects of Ulinastatin on Serum Cytokines Levels of Children Bitted by Agkistrodon Snake

目的研究乌司他丁对腹蛇咬伤儿童血清IL-6、IL-10水平的影响。方法 2006年7月-2009年10月本院急诊和普外科收治腹蛇咬伤儿童48例。随机分为乌司他丁治疗组(n=24)、常规治疗组(n=24)。常规治疗组按照经典的局部切开排毒、封闭+抗毒血清+脏器支持保护等治疗,乌司他丁治疗组加用乌司他丁针(10万U静脉滴注,2次.d-1,连续3d后改为5万U静脉滴注,2次.d-1,连续4d),另取健康儿童12例作为健康对照组。所有患儿于治疗前、治疗第1天、第3天及第7天(或死亡)采用ELISA检测其血清中促炎介质IL-6和抗炎介质IL-10水平,代表性评估患者的免疫状态。结果治疗前和治疗第1天2个治疗组IL-6无明显区别,但均明显高于健康对照组,2组于治疗第3天和第7天IL-6水平均明显降低(Pa<0.01),但乌司他丁治疗组较常规治疗组下降更加明显(P<0.05);与健康对照组比较,常规治疗组和乌司他丁治疗组IL-10水平在治疗前和治疗第1天均无明显差异,但第3天、第7天则高于健康对照组(P<0.01),但2个治疗组间无明显差异。其中常规治疗组1例死亡患儿IL-6水平持续增高,而IL-10的水平持续低于健康对照组。结论腹蛇咬伤儿童的免疫状态可出现紊乱,表现为早期促炎介质占优势,后期抗炎介质升高显著,乌司他丁可在一定程度上调节这种免疫状态。

Objective To investigate the effects of ulinastatin on serum interleukin（IL）-6,IL-10 of children bitted by agkistrodon snake.Methods Forty-eight children bitted by agkistrodon snake from Jul.2006 to Oct.2009 were included and randomly divided into regular treatment group（n=24） and ulinastatin treatment group（n=24）.Children in regular treatment group received conventional treatment,while those in ulinastain treatment group received conventional treatment plus ulinastatin therapy（100 000,vein drop,2 times per day for 3 days,then 50 000,vein drop,2 times per day for 4 days）.Twelve healthy children were enrolled as healthy control group.Serum IL-6 and IL-10 concentrations were detected by enzyme linked immunosorbent assay at admission and on day 1,3,and 7（or death） after treatment.Results Serum IL-6 levels in both treatment groups were higher than those in healthy control group,while no significant diffe-rence was found at admission and on day 1.IL-6 levels decreased significantly in both treatment groups on day 3,7（Pa0.01）,but much lower in ulinastain treatment group（P0.05）.At admission and on day 1,there were no significant difference of IL-10 levels between 2 treatment groups and control group.Serum IL-10 concentrations in 2 treatment groups were higher than those in control group on day 3 and day 7（P0.01）,but no significant difference were seen between 2 treatment groups.Moreover,persistently higher in IL-6 level and persistently lower in IL-10 than those in healthy control group were seen in 1 death case in regular treatment group.Conclusions There was a disorder of immune condition in children bitted by agkistrodon snake,which were characterized with exaggerated pro-inflammatory at early stage,but later exaggerated anti-inflammatory,and ulinastatin may benefit to the balance of this immune disorder.