急性肺血栓栓塞症时TNF-α IL-6 IL-10的水平及地塞米松的影响  

The level of TNF-α IL-6 IL-10 in acute pulmonary thromboembolism and the effect of daxamethasone

作　　者：张斗霞[1] 张凌[1] 白明[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院呼吸科,武汉430022

出　　处：《心肺血管病杂志》2005年第1期31-34,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的探讨兔急性肺血栓栓塞症(PTE)时血浆及支气管肺泡灌洗液(BALF)中肿瘤坏死因子α(TNFα),白细胞介素6(IL6)、白细胞介素10(IL10)的水平和肺组织病理变化及地塞米松(Dex)的影响。方法采用自体血栓回输法建立兔急性PTE模型。36只大耳白兔,随机分为对照组、Dex治疗组和PTE模型组各12只。用ELISA方法检测血浆及BALF中TNFα、IL6及IL10水平,术毕肺组织行病理观察。结果栓塞后2h,PTE模型组血浆TNFα及IL6分别高达(126±028,062±007)pgmL,与同期对照组TNFα、IL6(020±001,015±003)pgmL和Dxe治疗组TNFα,IL6(076±001,014±006)pgmL比较,P<001。栓塞后IL10水平持续升高时间较长,而且Dex治疗前后变化不大。BALF中上述细胞因子(CK)的变化与血浆中的水平基本一致。病理可见,PTE模型组兔肺组织明显萎缩,出血、膨胀不全,肺泡壁增厚,炎性细胞聚积,炎性渗出明显,肺小动脉内血栓形成,Dex治疗组兔肺组织病变较轻。结论PTE后促炎性细胞因子在引起肺部炎性反应和肺组织及肺动脉病损中起了重要作用,抗炎治疗可以明显减轻CK引起的这种损伤。抗炎治疗可能在降低其急性期病死率,改善远期预后的作用中不排除CK的因素。Objective:To investigate the change of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10)in the plasma and bronchoalveolar lavage fluid(BALF),and the changes of lung pathology and the effect of dexamethasone(Dex)in the pulmonary thromboembolism(PTE)rabbit model.Method:PTE model of rabbits was established by intravenous injection of autologous blood clots.36 rabbits were randomly divided into the normal grourp( n =12),Dex treatment group( n =12),PTE model group( n =12). The levels of TNF-α,IL-6,IL-10 in the plasma and BALF were measured with enzyme-linked immunosorbent assay(ELISA). At the end,the rabbits were sacrificed and lung removed for histopathologic with microscope.Result:After embolization 2 h,plasma TNF-α,IL-6 of PTE model rabbits were(1 26±0 28)pg/mL,(0 62±0 07)pg/mL,respectively. Meanwhile,those of normal group were 0 20±0 01 pg/mL, 0 15±0 03 pg/mL,respectively,and those of Dex treatment group were(0 20±0 01)pg/mL,(0 15±0 03)pg/mL,respectively. The value of PTE model group were significant higher than those of normal grourp and Dex treatment group( P <0 01).After embolization,IL-10 increased persistingly,and weren't effected by Dex. The changes of these cytokines(CK)in the BALF were almost same with those in plasma.Histopathologic analysis of the lung of PTE model group showed notable atrophy,hemorrhages,atelectasis,thickened alveolar walls,inflammatory cells accumulation and inflammatory effusion.There are thrombus in small pulmonary artery. However Dex treatment rabbits showed relative normal pulmonary structure.Conclusion:The inflammatory cytokines after PTE play an important role in the inflammatory injury of lung tissue and artery. Anti-inflammatory therapy may marked relieved the acute lung injury,and reduce mortality in the acute stage and improve later prognosis.CK may play an important role in these effects.

关 键 词：急性肺血栓栓塞症 地塞米松 肿瘤坏死因子Α 白细胞介素6 白细胞介素10 

分 类 号：R563.5[医药卫生—呼吸系统] R974[医药卫生—内科学]