严重急性呼吸综合征血液细胞因子的动态变化及其意义

Dynamic changes and the meanings of blood cytokines in severe acute respiratory syndrome

目的 探讨严重急性呼吸综合征 (SARS)患者血清白细胞介素 (ILs)、肿瘤坏死因子α(TNF α)及转化生长因子 β1(TGF β1)在不同病程时期的动态变化及其临床意义。方法 按采血时距SARS患者发病日期的长短分为 3～ 7天组、8～ 14天组及 >14天组 ,测定 62例SARS患者及 44例正常对照组血清中SARS病毒抗体及ILs、TNF α及TGF β1水平 ,并对其进行比较。结果 血清IL 6水平在3～ 7天组及 8～ 14天组处于对照组水平 ,>14天组高于对照组 (P <0 0 1) ;IL 8在 3～ 7天组处于对照组水平 ,8～ 14天组高于对照组 (P <0 0 5) ,>14天组升高更加明显 (P <0 0 1) ;IL 16及TNF α在各组均高于对照组 ,14天组升高更加明显 (P <0 0 1) ;IL 13在发病 3～ 7天组高于对照组 (P <0 0 1) ,8～ 14天组及 >14天组处于对照组水平 ;各组IL 18均持续低于对照组 (P <0 0 5) ;各组TGF β1持续高于对照组 ,>14天组虽有降低 ,但仍高于对照组 (P <0 0 1)。结论 SARS发病初期多数前炎细胞因子及TGF β1升高 ,可能与肺部渗出及增殖性病变有关 ,同时IL 13随病程进展逐渐降低 ,IL 18持续低于对照组。提示存在明显的免疫反应失调。观察血液细胞因子的动态变化 。

Objective To investigate the dynamic changes observed in serum levels of interleukins(ILs),tumor necrosis factor α(TNF α) and transforming growth factor β 1(TGF β 1) in severe acute respiratory syndrome(SARS) Methods Sixty one cases of SARS were classified into the following categories according to the duration from the onset of illness to the time blood was drawn:3 7 day group,8 14 day group and over 14 day group Forty four healthy individuals served as the control Serum levels of ILs,TNF α and TGF β 1 were measured in all cases Serum antibodies to SARS coronavirus(SARS CoV) were measured only in SARS cases Results The mean concentration of serum IL 6 in SARS patients did not differ from the control group in 3 7 day group and 8 14 day group,but became significantly higher in over 14 day group as compared to the control group,3 7 day group and 8 14 day group ( P< 0 01) The mean concentration of serum IL 8 in SARS patients did not differ from the control group in 3 7 day group ,were significantly higher than the control group in 8 14 days group and in over 14 day group( P< 0 05)and significantly higher in over 14 day group than in 3 7 day group and 8 14 day group( P< 0 01) The mean concentration of IL 16 and TNF α in all groups of SARS was higher than that of the control group,but it was the highest in over 14 day group( P< 0 01) SARS patients experienced higher concentration of serum IL 13 as compared to controls in 3 7 day group( P< 0 01),but it returned to normal levels in 8 14 day group and the over 14 day group The mean concentration of serum IL 18 in SARS patients was significantly lower than that of the control group during all groups of SARS patients( P< 0 05);The mean concentration of TGF β 1 in all groups of SARS patients was higher than that of the control group Although TGF β 1 in sera decreased in over 14 day group,the average was still higher than that of the control group( P< 0 01) Conclusions Proinflammatory cytokines and TGF β 1 were elevated during the early phase of SARS,a phenomenon which may be associated with lung infiltration and proliferation Concurrently,the mean concentration of serum IL 13 decreased gradually and the mean concentration of serum IL 18 level in SARS patients was lower than that of the control group during the whole disease course It suggested that the immune state of SARS was obviously abnormal Observing the dynamic changes in blood cytokine levels can provide us with a scientific basis to assess pathogenesis and efficacy of clinical treatment of SARS