急性有机磷中毒患者内毒素和肿瘤坏死因子与多器官功能障碍综合征的相关研究

The Relationship between the Changes in Plasma Endotoxin,Tumor Necrosis Factor Levels and Multiple Organ Dysfunction Syndrome in Patients with Severe Acute Organophosphorus Pesticidr Poisoning

目的 探讨血浆内毒素 (LPS)及肿瘤坏死因子 (TNF)在中重度急性有机磷中毒 (AOPP)后多器官功能障碍综合征 (MODS)发生发展中的作用机制及其临床意义 .方法 应用动态浊度法及放射免疫法动态监测 46例中重度AOPP患者血浆LPS和TNF和水平 ,比较MODS组与非MODS组及正常对照组LPS及TNF的变化 .结果 46例患者血浆LPS及TNF水平均明显升高 ,较正常对照组差异有非常显著性 (p均 <0 0 1) ,且血浆高水平持续较长时间 ,MODS组升高的峰值较非MODS组更显著 (p <0 0 5和p <0 0 1) .结论 中重度AOPP的早期即可导致内毒素血症的发生 ,内毒素可能是导致炎性介质产生和释放的重要机制 ,是有机磷中毒机制的重要组成之一 .

Objective To investigate the clinical signifcance and potential mechanism of plasma endotoxin and tumor necrosis factor (TNF) in the pathogenesis of multiple organ dysfunction syndrome(MODS) associated with severe acute organophosphorus pesticide poisoning (AOPP).Methods Plasma endotoxin and TNF levels in 46 patients with severe AOPP were detected dynamically by dynamic turbidity and radioimmunoassay,respectively. Results plasma endotxin and TNFlevels were elevated obviously and kept in high level in all 46 cases,and there were significantly different between patients with severe AOPPand normal controls (all p<0 01).Also,peak values in MODS group were markedly higher than that in non-MODS group (p<0 05) and p<0 01).Conclusions Endotoxemia may occur in early period of AOPP,and endotoxin may be one of important factors resulting in the release of inflammatory mediators,High levels of endotoxin and TNF may be involved in the development of MODS following severe AOPP.