磷脂酶A_2及细胞因子在危重病中的作用研究

A study on the roles of phospholipase A 2 and cytokines on critical illness

目的 探讨危重病时磷脂酶Ａ２（ＰＬＡ２） 及细胞因子［ 肿瘤坏死因子（ＴＮＦα） ，ＩＬ６，ＩＬ８ ］的作用及意义。方法 采用ＥＬＩＳＡ法检测６５ 例患儿及２０ 例正常健康儿血清ＰＬＡ２ 及细胞因子水平，结合脏器功能监护及血糖（ＧＬＵ） 、血乳酸（ＬＡ） 及ＰａＯ２ 的监测。结果 危重组ＰＬＡ２ 、ＴＮＦα、ＩＬ６ 、ＩＬ８分别为（０－６８１±０－５７９） ｍｇ／Ｌ、（０－５１８±０－３３６） ｍｇ／Ｌ、（５－５±２－２） ｍｇ／Ｌ、（０－５０８±０－３２８） ｍｇ／Ｌ，较对照组的（０－１７１±０－０１９） ｍｇ／Ｌ、（０－０８２±０－００９） ｍｇ／Ｌ、（２－３±０－６） ｍｇ／Ｌ、（０－０５２ ±０－０１９） ｍｇ／Ｌ显著增高（Ｐ均＜ ０－００５）；小儿危重病例评分≤７０ 分组ＰＬＡ２ 、ＴＮＦα、ＩＬ６、ＩＬ８ 分别为（１－３ ±０－７） ｍｇ／Ｌ、（０－８ ±０－３）ｍｇ／Ｌ、（７－７ ±１－８） ｍｇ／Ｌ、（０－７１±０－１８） ｍｇ／Ｌ，较７１～８９ 分组的（０－５１±０－１４） ｍｇ／Ｌ、（０－４３±０－１５） ｍｇ／Ｌ、（５－５±０－９） ｍｇ／Ｌ、（０－５３ ±０－１０） ｍｇ／Ｌ明显增高（ Ｐ＜ ０－０５ 或?

Objective To study the roles of phospholipase A 2 (PLA 2) and cytokines (CKs) in children with critical illness Methods The serum concentrations of PLA 2 and CKs were determined in 65 children with critical illness and 20 healthy children by ELISA method The glucose and lactate levels and arterial blood oxygenic pressure were measured simultaneously along with the organ functions Results PLA 2, TNF α, IL 6 and IL 8 (mg/L) levels in the acute stages of the illness were (0 681±0 579) mg/L, (0 518±0 336) mg/L, (5 5±2 2) mg/L, (0 508±0 328) mg/L, respectively, which were significantly elevated as compared with those of controls [(0 171±0 019) mg/L, (0 082±0 009) mg/L,(2 3±0 6) mg/L, (0 052±0 019) mg/L] The mean values of PLA 2 TNF α, IL 6 and IL 8 in children with critical care scores under 70[(1 3±0 7) mg/L, (0 8±0 3) mg/L, (7 7±1 8) mg/L, (0 71±0 18) mg/L] and those of the multiple systemic organ failure were significantly higher than those with scores of 71～89 [(0 51± 0 140 mg/L, (0 43±0 15) mg/L, (5 5±0 9) mg/L, (0 53±0 10) mg/L]. The mean values of PLA 2 and CKs in children with multiple systemic organ failure were significantly higher than those with single organ failure ( P <0 05, or P <0 01) The mean serum concentrations of PLA 2 and CKs were remarkedly higher in children with deteriorative diseases than in children with recoverable diseases, and were the highest in deathbed children ( P< 0 001) The serum PLA 2 levels correlated positively with the CKs, glucose and lactate levels, and negatively with PaO 2 and critical care scores Conclusion PLA 2 and CKs are involved in all pathophysiologic processes of the development of critical illness Combined with critical care scores, PLA 2 and CKs are probably useful clinical values for evaluation of the severity and prognosis of critical illness