重症急性胆管炎时核因子-kB活性的变化及其临床意义

Change of Nuclear Factor Kappa B Activity in Patients with Acu te Cholangitis of Severe Type and Its Clinical Significance

目的 观察重症急性胆管炎 (ACST)患者术后外周血单核细胞 (PBMC)中核因子 kB(NF kB)活性的变化及其与胆道感染严重程度和预后的关系。方法 2 0例ACST患者根据其预后情况分为生存组 ( 14例 )和死亡组 ( 6例 ) ,同时选择胃溃疡行大部切除术或疝修补术等非炎症疾病患者 10例作为对照组 ,分别于术后 2 4h取外周血 ,用密度梯度离心法分离PBMC ,提取核蛋白 ,并用凝胶电迁移改变分析法 (EMSA)测定PBMC中NF kB活性的变化 ,所得结果用图像分析仪分析并以相对光密度 (ROD)表示。用酶联免疫法 (ELISA)测定血浆中TNF α、IL 6和IL 10含量的变化。结果 ACST死亡组NF kB活性最高 ( 5.0 2± 1.0 3 ) ,生存组次之 ( 2 .98± 0 .51) ,对照组最低 ( 1.0 2± 0 .3 4 ) ,各组间比较差异有显著性意义 (P<0 .0 5)。ACST死亡组血浆TNF α和IL 6含量明显增高 ,分别为 ( 4 96.2 8± 52 .3 5)ng/L和 ( 578.13±67.72 )ng/L ,生存组分别为 ( 2 84.47± 3 9.41)ng/L和 ( 3 18.67± 3 4 .92 )ng/L ,对照组分别为 ( 89.43± 10 .3 9)ng/L和( 10 1.2 7± 13 .47)ng/L ,各组间比较差异有显著性意义 (P<0 .0 5)。ACST死亡组和生存组IL 10分别为 ( 3 78.42± 41.0 2 )ng/L和 ( 3 84.75± 3 9.2 4)ng/L ,均明显高于对照组的 ( 69.3

Objective To determine the nuclear fa ctor kappa B (NF-kB) activity in peripheral blood mononuclear cells (PBMC) in patients with acute cholangitis of severe type (ACST) and correlate the degree o f NF-kB activation with severity of biliary tract infection and clinical outcom e.Methods Twenty patients with ACST were divided into survivor group (14 cases) and nonsurvivor group (6 cases). Other 10 patient s undergoing elective gastrectomy or inguinal hernia repair were selected as con trol group. Peripheral blood samples were taken 24 hours after operation, PBMC w as separated and nuclear proteins were isolated from PBMC, and NF-kB was determ ined with electrophoretic mobility shift assay (EMSA) . The levels of TNF-α , IL-6 and IL-10 in plasma were determined by using an enzyme-linked immunoas say (ELISA). Results The NF-kB activity was 5.02±1.03, 2.9 8±0.51 and 1.02±0.34 respectively in three groups. It was increased in all pat ients with ACST, versus the control group ( P < 0.05), and the patients of nonsurvivor group had higher levels of NF-kB ac tivation than those of survivor group ( P < 0.05). The levels of TNF-α and IL-6 were (496.28±52.35) ng/L and (578.13± 67.72) ng/L in nonsurvivor group; (284.47±39.41) ng/L and (318.67±34.92) ng/L in survivor group; (89.43±10.39) ng/L and (101.27±13.47) ng/L in contro l group. All patients with ACST had increased levels of TNF-α and IL-6, which were many fold greater than that of control group, and there was an eviden ce of significantly higher levels in nonsurvivor group than in survivor group ( P <0.05). All patients had also increased levels of IL-10 as compared to control group ( P < 0.05), but the IL-10 concentrations in plasma were not significantly higher in nonsurvivors than that of in those survivors ( P >0.05). Conclusion NF-kB activation in PBMCs in patien ts with ACST increased markedly and the degree of NF-kB activation was cor related with severity of biliary tract infection and clinical outcome.