危重病患者多器官功能障碍综合征细胞因子变化的意义

Clinical study of plasma cytokines in critical patients with multiple organ dysfunction syndrome

目的 探讨肿瘤坏死因子 -α(TNF -α)、白细胞介素 1β(IL - 1β)、白细胞介素 6 (IL - 6 )、白细胞介素 8(IL - 8)、白细胞介素 10 (IL - 10 )在危重病多器官功能障碍综合征 (MODS)病理过程中的作用及其临床意义。方法 采用酶联免疫吸附(ELISA)法检测 48例不同类型的危重病患者血清TNF -α、IL - 1β、IL - 6、IL - 8、IL - 10的含量 ,并分析 36例MODS患者器官衰竭数与死亡率的关系。结果 MODS组与非MODS组血清TNF -α、IL - 1β、IL - 6、IL - 8、IL - 10含量水平均较对照组明显升高 ,尤以MODS组最为明显 (P <0 0 1) ,且IL - 6、IL - 8、IL - 10峰值升高时限滞后于TNF -α、IL - 1β,IL - 10升高最晚。MODS组 36例患者二脏衰死亡率为 5 4 5 % ,三脏衰为 80 % ,≥四脏衰为 10 0 %。结论 细胞因子TNF -α、IL - 1β、IL - 6、IL - 8、IL - 10的异常释放可能参与了危重病MODS的病理过程。MODS的病死率与脏器衰竭数呈正相关。

Objective To study the clinical significance and potential mechanism of plasma tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10) in the pathogenesis of multiple organ dysfunction syndrome(MODS) associated with critical patients Methods Plasma TNF-α?IL-1β?IL-6?IL-8?IL-10 levels were measured in 48 critical patients by using enzyme-linked immunosorbent assay(ELISA)method The relationship between the number of failure organs and the mortality of MODS were analyzed in 36 cases of MODS and non-MODS,too Results Plasma TNF-α?IL-1β?IL-6?IL-8?IL-10 levels were significantly higher in MODS and non-MODS group,especially in MODS group than that of healthy controls ( P <0 01) The time of reaching the peak values in IL-6?IL-8?IL-10 were slower than that in TNF-α?IL-1β,IL-10 was slowest The mortalities of combined 2?3 and 4 failure organs were 54.5%?80%?100% in MODS group.Conclusions The abnormal release of the TNF-α?IL-1β?IL-6?IL-8?IL-10 plays an important role in the pathophysiology of MODS associated with critical patients The mortality of MODS increases with the number of failure organs