严重烧伤早期痂下水肿液细胞因子及免疫功能的临床观察

Changes in proinflammatory cytokines and immune function of subeschar tissue fluid during early stage after severe burn

目的 :探讨严重烧伤早期痂下水肿液的炎症介质和免疫功能指标的改变与意义。方法 :选择 8例严重烧伤患者 ,分别采集伤后 16、2 4、32、4 0和 4 8h 5个时间点的血液和痂下水肿液标本 ,对其肿瘤坏死因子 α(TNFα)、白介素 6 (IL 6 )、IL 8、白细胞总数、免疫球蛋白 Ig A、Ig G、Ig M及补体 C3、C4含量进行对比观察 ;并用伤后 4 8h的痂下水肿液攻击 2 0只 Balb c小鼠以观察其致死效应。结果 :痂下水肿液中 Ig A、Ig G、Ig M及补体 C3、C4含量仅为同一时间点血液含量的 1/ 2左右 (P均 <0 .0 1) ;白细胞总数为血液的 1/ 10 0 (P均 <0 .0 1) ;TNFα、IL 6、IL 8含量与血液中水平基本保持一致 (P均 >0 .0 5 )。而急性毒性实验显示无一只小鼠死亡。结论 :相对于小分子物质而言 ,细胞及大分子物质如免疫球蛋白、补体等较难进入痂下水肿液 ;严重烧伤早期痂下水肿液无明显的局部炎症反应发生 ,亦无明确的致死作用 ;低白细胞计数、免疫球蛋白及补体含量提示局部抗感染能力低下 ,此时应注意抗生素的早期、有效使用。

Objective: To evaluate the inflammatory response and immune function of subeschar tissue fluid (STF) in early stage of severe burn. Methods: Eight patients were observed and samples from blood as well as STF were collected at 16, 24, 32, 40, 48 hours following burn to measure white blood cell (WBC) counts, levels of immunoglobin (IgA, IgG, IgM), complement (C3, C4) values as well as proinflammatory cytokines as tumor necrosis factorα(TNF-α), interleukin-6(IL-6) and IL-8. In addition, twenty Balb-c mice were used for the lethal experiment by STF collected at 48 hours after burn. Results: The levels of IgA, IgG, IgM in STF were about half of those in the blood samples (all P<0.01). The WBC counts in STF were 1/100 time of that in the blood (all P<0.01). The contents of TNF-α, IL-6 and IL-8 in STF were comparable with those in the blood (P>0.05). Following STF challenge, none of the mice died during 7-day observation period. Conclusion: The cells and large molecules seems to be more difficult to enter STF compared with small molecules. No marked local inflammatory response occurs in STF during early stage of severe burn, and STF challenge has no lethal effect. The low WBC counts and low immunoglobin as well as complement levels imply the limited effect of STF on local infection, and effective antibiotics should be timely used after major burn.