炎症反应与急性主动脉夹层肺损伤相关性研究

Correlation between inflammatory reaction and pulmonary injury in patients with acute aortic dissection

目的通过检测患者血清超敏C反应蛋白(CRP)、白介素-6 (IL-6)、肿瘤坏死因子-ɑ(TNF-ɑ)的水平,探讨炎症反应与急性主动脉夹层(AAD)肺损伤的相关性。方法对2015年1月至2017年12月我院收治的67例符合标准的AAD患者进行研究分析。将患者分为肺损伤组(PaO2/FiO2≤300)(A组)和非肺损伤组(PaO2/FiO2>300)(B组),随机选择30例健康体检者进行空白对照(C组)。检测并比较分析患者入院时及入院后每隔12小时血清CRP、IL-6、TNF-ɑ水平。结果 A、B两组CRP、IL-6、TNF-ɑ入院时水平与C组差异无统计学意义(P>0.05),入院后24小时水平与C组差异有统计学意义(P<0.05);A、B两组入院后24小时水平差异有统计学意义(P<0.05),两组峰值水平差异有统计学意义(P<0.05)。发病后A、B两组CRP和IL-6、TNF-ɑ水平不断上升,PaO2/FiO2逐渐降低,随着发病时间的推移,上述因子水平达到峰值后下降,PaO2/FiO2逐渐回升,两者密切相关(r值分别为-0.895、-0.774、-0.902)。结论 AAA所致的肺损伤与炎症反应密切相关。炎症因子的浓度不仅可以反映主动脉夹层炎症反应的剧烈程度,还可以预示患者肺损伤的严重程度。因此,连续监测血液中炎症因子的水平,可以帮助预测病情,积极采取抗炎等相关措施,可能对于减轻肺损伤和改善患者预后有一定临床意义。

Objective To investigate the relationship between acute systemic inflammation and lung injury in patients with acute aortic dissection(AAD)by detecting serum levels of hypersensitive C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α).Methods From January 2015 to December 2017,67 patients with AAD who met the inclusion criteria in our hospital were studied and analyzed.Patients were divided into lung-injury group(PaO2/FiO2≤300)(group A)and non-lung-injury group(PaO2/FiO2>300)(group B),otherwise 30 healthy people were randomly selected as control group(group C).The serum levels of CRP,IL-6 and TNF-TNF-were measured every 12 hours once they were admitted to hospital.Results There was no significant difference in serum CRP,IL-6 and TNF-αlevels between group A or group B and blank group on admission(P>0.05),while significant differences were found 24hs after admission(P<0.05).Also,the significant differences were found between group A and group B 24hs after admission(P<0.05),as well as the peak level of the two groups(P<0.05).After onset,the serum levels of CRP,IL-6 and TNF-αin group A and B increased continuously,while the serum levels of PaO2/FiO2 decreased gradually.As the disease progressing,the serum levels of CRP,IL-6 and TNF-αgradually decreased after reaching their own peak,while the PaO2/FiO2 gradually increased,which were closely negatively related(r values were-0.895,-0.774,-0.902,respectively).Conclusion Pulmonary injury caused by acute aortic dissection is closely related to inflammation.The serum levels of inflammatory factors can not only reflect the severity of inflammatory reaction in aortic dissection,but also predict the severity of lung injury.Therefore,continuous monitoring the levels of inflammatory factors in the blood can help to predict the disease condition,actively take anti-inflammatory measures and other related measures may have significant clinical significance in reducing lung injury and improving the prognosis of patients.