蝮蛇伤患者外周血单核细胞核因子-κB活性的变化及其临床意义

Chang of nuclear factor - Kappa B activation in peripheral blood mononuclear cells in the patients bitten by agkistrodon halys and its clinical significance

目的测定蝮蛇伤患者外周血单核细胞核凶子-κB（NF-κB）的活性，探讨其临床意义。方法80例蝮蛇伤患者根据入院时中毒程度分为轻型、重型、危重型；根据全身炎症反应综合征（SIRS）诊断标准分为SIRS组和非SIRS组；根据多器官功能障碍综合征（MODS）诊断标准分为MODS组和非MODS绀；根据抗蝮蛇毒血清干预的时间分为于预前组、干预6h组、干预24h组。所有患者均于人院后未作任何处理前和注射抗蝮蛇毒m清后6h、24h三个时相点采集外周血标本，采用酶联免疫吸附试验（ELISA）方法测定外周血中单核细胞NF-κB的活性，比较各组NF-κB的活性。取同期30例健康志愿者为对照组。结果轻型、重型、危重型患者NF—KB活性两两比较差异有统计学意义（P〈0．05），各型与对照组比较差异有统计学意义（P〈0．05）；SIRS组与非SIRS组NF-κB活性比较差异有统计学意义（t=4．05，P〈O．05）；MODS组与非MODS组NF-κB活性比较差异有统计学意义（t=4．60，P〈0．05）。干预前组、干预后6h及24h组NF-κB活性两两比较差异有统计学意义（P〈0．05）、，结论蝮蛇毒素可使NF-κB被激活，NF-κB的激活可能参与了蝮蛇伤患者病情的发生、发展过程；蝮蛇伤患者SIRS、MODS的发生与NF-κB的过度活化密切相关。。

Objective To measure the activity of nuclear factor - Kappa B （NF -κB） in peripheral blood mononuclear cells in the patients by agkistrodon halys and to explore the relationship between tile activity of NF -κB and degree of disease severity. Methods The 80 patients bitten by agkistrodon halys, according to clinical elassifieation and severity degree score standard of venomous snake bite, were divided into three types according to poisoning degree on admission： mild, severe and critical type; Patients were divided into two groups according to SIRS diagnostic criteria： SIRS group and non -SIRS group; Patients were divided into two groups according to MODS diagnostic criteria： MODS group and non - MODS group. In accordance to the time of agkistrodon antivenins, the patients were divided into pre - intervention, 6 h after the intervention, 24 h after the intervention group. Blood samples of all the patients were collected on admission without any intervention, at 6 h ＇after giving anti - agkistrodon venom serum, 24 h after the intervention. The aetivity of NF -κB was measured by enzyme- linked imumnosorbent assay in peripheral blood mononuclear cells, the difference of the activity of NF -κB was compared respectively. 30 healthy people were regarded as control group.Results There were significant differences in NF -κB levels between mild, severe and critical type respectively（ P 〈 0.05 ）. Compared with control group, there was significant difference in NF -κBlevels among 3 groups of different types（P 〈0.05）. There was significant difference between SIRS group and non - SIRS group（ t = 4.05,P 〈 0.05 ）, between MODS group and non - MODS group （ t = 4.60, P 〈 O. 05）. Pairwise comparisons of different intervention time groups had significant difference in NF -κB levels（ P 〈 O. 05 ）. Conclusion Venomin can activate NF -κB, the activation of NF -κB participates in the onset and development of pathogenetic condition in patients bitten by agkistrodon halys possibly. The occurrence of SIRS and MODS are clearly associated with activation of NF -κB in the patients bitten by agkistrodon halys.