重症急性胰腺炎患者IL-6 TNF-α IL-10 TGF-β和CRP的临床分析

目的探讨促炎、抗炎细胞因子和C反应蛋白（CRP）对重症急性胰腺炎的免疫调节作用。方法回顾性分析2012年1月至2014年12月78例急性胰腺炎患者临床资料，根据急性生理和慢性健康状况评分（APACHEⅡ）系统分为轻度（MAP）（n=21）、中度（MSAP）（n=34）和重度（SAP）（n=23），检测入院后第1、3、5、7d患者血清中白细胞介素-6，10（IL-6，IL-10），肿瘤坏死因子-α（TNF-α），转化因子β（TGF-β）和CRP的表达情况。结果入院3d后急性胰腺炎患者血清中IL-6，TNF-α，IL-10，TGF-β，CRP均明显升高（P〈0．05），随后第5、7d，轻，中症急性胰腺炎患者血清中IL-6、TNF-α、IL-10、TGF-β、CRP降低，而重症急性胰腺炎血清中IL-6、TNF-α、IL-10、TGF-β、CRP持续升高（P〈0．05）并保持较高水平，且与APACHEⅡ系统评分高低呈现正相关。结论血清中IL-6、TNF-α、IL-10、TGF-β、CRP水平高低反映SAP患者病情严重程度，APACHEⅡ系统评分与患者发生局部或全身性炎症反应综合征显著相关。

Objective To evaluate the roles of inflammatory, anti-inflammatory factors and CRP in the immunity pathogenesis of severe acute pancreatitis. Methods 78 cases who were admitted to our hospital with acute pancreatitis from January 2012 to December 2014 were selected and divided into 21 MAP, 34 MSAP and 23 SAP with the standard of severity according to APACHE Ⅱ scoring system. The serum IL-6, TNF-α, IL- 10, TGF- 13 and plasma CRP levels of three group were measured on admission and then on day 3, 5 and 7. Results The levels of IL-6, TNF- α, IL- 10, TGF- β and CRP inceased and peaked on day 3 in all three group （ P〈0.05 ） , After peaking, the level decreased slowly in the mild and moderate groups on day 5 and 7.In severe group, the levels peaked on day 3 and 5, and maintain on day 7. The levels of inflammatory, anti-inflammatory factors and CRP changed and kept pace with the APACHE Ⅱ scoring system. Conclusion There is a strong positive correlation between the levels of IL-6, TNF- α, IL-10, TGF- β, CRP and seriousness of patient＇ s condition, which indicates the significant relationship between APACHE Ⅱ scoring system and local or systemic inflammatory response syndrome.