急性百草枯中毒血清炎性细胞因子的临床意义

Clinical significance of dynamic changes in serum inflammatory cell factors after acute paraquat poisoning

目的 探讨急性百草枯中毒（APP）患者血清中β-内啡呔（β-EP）、内皮素（ET）、肿瘤坏死因子（TNF）、一氧化氮（NO）等炎性细胞因子的临床意义.方法 测定26例急性百草枯中毒患者血清中β-EP、ET、TNF、NO的浓度,以患者亲属中20例健康自愿者的血清作为对照进行分析和比较.结果 26例急性百草枯中毒患者中治愈10例,死亡16例.生存组10例患者的β-EP,ET,TNF,NO血清浓度均于入院后即刻增高,第2天为高峰,之后缓慢下降,于9d后接近正常;死亡组16例患者入院时血清中β-EP、ET、TNF、NO浓度已明显增高,在治疗过程中仍然逐渐上升.与生存组比较,死亡组血清中β-EP、ET、TNF、NO浓度均明显增高,差异有统计学意义（P＜0.01）.结论 急性百草枯中毒死亡患者血清中β-EP、ET、TNF、NO浓度明显高于生存患者,且持续上升,并处于高水平状态,预示病情严重.

Objective To investigate the clinical significance of dynamic changes in the serum inflammatory cell factors consisting of β-endorphin （β-EP）,endothelins （ET）,tumor necrosis factor （TNF）,and nitric oxide （NO） after acute paraquat poisoning （APP）.Methods The 26 patients with APP （as observation group） were treated and the serum levels of plasma β-EP,ET,TNF,and NO were measured simultaneously.The 20 healthy volunteers from relatives of the patients （as control group） were also included in the study and their serum levels of β-EP,ET,TNF,and NO were measured.Results In the 26 patients with APP,10 were cured and 16 died.The serum levels of β-EP,ET,NO,and TNF in the 10 cured patients increased significantly immediately after admission,reached the peak values on day 2,and then decreased gradually and returned to the normal ranges after day 9.The serum levels of β-EP,ET,NO,and TNF in the 16 dead patients increased significantly on admission and kept rising in the course of treatment.The dead patients had significantly increased serum levels of β-EP,ET,NO,and TNF compared with the cured patients （all P 〈0.01）.Conclusion Compared with those in cured patients with APP,the serum levels of β-EP,ET,NO,and TNF in dead patients with APP are significantly higher,keep rising,and maintain at high levels,indicating a severe condition.