内毒素及其诱生细胞因子与急性胰腺炎患者临床预后的关系

Correlation of endotoxin and its inductive cytokines with clinical prognosis of acute pancreatitis.

目的 动态观察血浆内毒素及其诱生细胞因子TNF-α、IL-1β水平在急性胰腺炎(AP)患者中的变化,探讨其在AP发生、发展中的作用及其与AP患者临床预后的关系。方法 联合应用Ranson标准、APACHEⅡ评分和Balthazar CT分级系统将17例确诊为AP的患者分为轻型急性胰腺炎(MAP)13例和重症急性胰腺炎(SAP)4例,并于入院后第1、2、3、4、5天连续监测患者血浆内毒素水平和血清TNF-α、IL-1β水平。结果 SAP组患者内毒素水平于入院后第2天起较MAP组显著升高,血清TNF-α和IL-1β水平于入院后第1天和入院后第5天较MAP组显著升高(P<0.05)。AP患者血浆内毒素水平于入院后第4天起与血清TNF-α水平呈直线正相关,AP患者血浆内毒素水平自第2天起与IL-1β水平呈直线正相关。结论 内毒素及其诱生细胞因子水平的高低与AP病情严重程度一致。因此这些指标在判断MAP和SAP以及衡量AP预后方面具有重要的参考价值。

Objective To explore the role of endotoxin and its inductive cytokines TNF-α and IL-1β in the development and progression of acute pancreatitis (AP) and their association with clinical prognosis of AP. Methods Seventeen consecutive patients with AP were diagnosed and divided into 13 cases of mild acute pancreratitis (MAP) and 4 cases of severe acute pancreatitis (SAP) prospectively according to Ranson's criteria, APACHE I and Balthazar CT scoring systems. Plasma levels of endotoxin and serum levels of TNF-a and IL-lβ were measured at day 1, 2, 3, 4 and 5 after admission. Results Compared with MAP group, endotoxin levels were significant high at day 2, 3, 4 and 5, while serum levels of TNF-aand IL-1β were significant high at day 1 and 5 in SAP group(P < 0. 05). There was a positive lineal correlation between plasma endotoxin levels and serum levels of TNF-a at day 4 and 5, and between plasma endotoxin levels and serum levels of IL-lfi at day 2,3,4 and 5 day after admission. Conclusions Our studies indicate that levels of endotoxin and its inductive cytokines are consistent with the severity of AP, and therefore they may serve as indices in predicting MAP or SAP and assessing the prognosis of AP.