SIRS期血中相关细胞因子及肾血流动力学变化的临床意义探讨

Clinical significance of changes in plasma mediators and renal hemodynamics in patients with systemic inflammatory response syndrome

目的 :探讨全身性炎症反应综合征 (SIRS)期血中相关细胞因子肿瘤坏死因子 α(TNFα)、内皮素(ET)、超氧化物歧化酶 (SOD)和肾血流动力学变化与肾损害的关系 ,寻找早期、无创性诊断急性肾功能衰竭(肾衰 )方法 ,并进行系统相关性研究。方法 :用放射免疫法测定 2 6例 SIRS患者和 15例正常人血浆 TNFα、ET和 SOD的含量 ,并进行 Spect肾动态显像和肾彩色多普勒血流显像。结果 :核素、多普勒肾动态显像变化可出现在 SIRS期 ,早于传统的生化指标血尿素氮 (BUN )、肌酐 (Cr)及尿量改变。发生多脏器功能失常综合征(MODS)时肾衰组 ET、TNFα和 SOD均高于无肾衰组和正常对照组 (P<0 .0 5或 P<0 .0 1)。结论 :动态监测血中相关细胞因子水平与肾血流动力学变化 ,对预测肾功能损害程度、转归密切相关。核素、彩色多普勒肾动态显像是评价 MODS时肾功能、肾血流状态的一种简便、无创、有效的诊断方法。

Objective:To study the clinical significance of changes in plasma mediators and renal hemodynamics in patients with systemic inflammatory response syndrome (SIRS),and their correlation with the development of acute renal failure(ARF).Methods:Plasma endothelin (ET),tumor necrosis factorα (TNFα) ,and superoxide dismutase (SOD) levels were measured in 26 patients with SIRS and 15 healthy volunteers (control group) by radioimmunoassay,then dynamic scintirenography by Spect and Color Doppler imaging was also performed in these cases.Results:Abnormal dynamic scintirenography could be found in patients during SIRS via Spect and Color Doppler,and it was earlier than the change in routine biochemical parameters,including blood urea nitrogen(BUN),creatinine(Cr) and urine volume.In patients with multiple organ dysfunction syndrome (MODS),levels of ET,TNFα,SOD in renal failure group were significantly higher than that in nonrenal failure group and normal controls( P <0 05 or P <0 01).Conclusions:Plasma ET,TNFα,SOD and renal hemodynamic changes may be useful parameters to reflect renal conditions and prognosis.Scintirenography and Color Doppler is a highly effective,convenient diagnostic method in evaluating the renal function and the blood flow in patients with MODS.