p38MAPK和COX-2 mRNA在创伤后多器官功能障碍综合征患者外周血中的表达

Expression of COX-2 and p38MAPK of peripheral blood mononuclear cells in trauma patients with multiple organ dysfunction syndrome

目的探讨创伤后多功能障碍综合征（multiple organ dysfunction syndrome，MODS）患者外周血单核细胞（peripheral blood mononuclear cells，PBMCs）环氧化酶-2（cyclooxygenase-2，COX-2）与p38丝裂原活化蛋白激酶（p38 mitogen-activated protein kinase，p38MAPK）mRNA的表达以及与MODS病情变化的关系。方法选择符合1995年中华医学会急诊分会危重病专业组制定的MODS病情分期诊断标准和1991年Knaus提出急性生理和慢性健康评分Ⅲ（APACHEⅢ）的患者40例，其中男22例，女18例；与患者年龄、性别相匹配的健康对照组40名。用酶联免疫吸附试验法（ELISA）检测PBMCs培养上清液COX－2与p38MAPK含量；用逆转录一聚合酶链反应（RT．PCR）法检测PBMCs中COX-2与p38MAPK的mRNA表达。并分析它们的表达与APACHEllI评分的相关性。结果MODS组患者PBMCs的COX-2与p38MAPK含量及两者的mRNA表达均显著高于健康对照组（均P〈0．05）；MODS死亡患者PBMCs的COX-2与p38MAPK含量及两者的mRNA表达与存活患者比较，差异具有统计学意义（均P〈0．05）；相关分析显示，PBMCs培养上清液中COX-2与p38MAPK含量呈正相关（r=0．6147，P〈0．01）；患者PBMCs的COX-2和p38MAPK mRNA表达与APACHEⅢ评分呈正相关（r1=0．5009，P1〈0．05，r2=0．5316，p2〈0．05）。结论COX-2与p38MAPK参与了MODS的发病过程，而且可作为判断MODS预后的辅助指标。

Objective To explore the expression of COX-2 and p38MAPK in patients with trauma MODS. Methods Forty MODS patients were evaluated. The levels of peripheral blood mononuelear ceils COX-2 and p38MAPK in MODS patients and 40 normal controls was detected by enzyme linked immunosorbent assay（ELISA）. RT-PCR was used to measure the COX-2 mRNA and p38MAPK mRNA expression of in PBMCs. ANOV and correlation analysis were used in statistical analysis. Results The levels of COX-2 and p38MAPK of PBMCs and the mRNA expression in MODS group were higher than in control group（ all P 〈0.05）. The levels of COX-2 and p38MAPK of PBMCs and the mRNA expression in dead group were higher than in survival group（ all P 〈0.05）. The levels of COX-2 and p38MAPK of PBMCs were positively correlated, （r =0.6 147, P 〈0.01）. The expression of COX-2 mRNA, p38MAPK mRNA of PBMCs and A-PACHE Ⅲ scoring were positively correlated （ r1 = 0.5 009, P1〈 O. 05, 2 = 0.5 316, P2 〈 0.05 ）. Conclusions COX-2 and p38MAPK of PBMCs take part in the onset of MODS, and may service as index to judge the prognosis of MODS.