肿瘤坏死因子α在流行性出血热发病中的作用  

Tumor necrosis factor alpha in epidermic hemorrhaegic fever

作　　者：郑丰[1] 黎磊石[1] 肖申[1] 汤兵 张真 周虹[1] 许瑞吉 

机构地区：[1]南京金陵医院解放军肾脏病研究所

出　　处：《肾脏病与透析肾移植杂志》1995年第5期405-413,共9页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：在选择观察的６例流行性出血热（ＥＨＦ）患者中（重型２例，中型２例，轻型２例），发现有２例重型和１例中型患者的外周血单个核细胞（ＰＢＭＣ）表达肿瘤坏死因子α（ＴＮＦα）ＴｎＲＮＡ，特别以低血压休克期表达最为明显。同时应用免疫ＰＡＰ法对ＰＢＭＣ进行染色显示，病情重伴低血压休克或有明显肾功能损害的患者ＰＢＭＣ中ＴＮＦα阳性细胞数增加。ＥＨＦ患者除单核／巨噬细胞外，部分淋巴细胞和肾小管细胞ＴＮＦα染色亦呈阳性。动态观察ＥＨＦ患者（１０例重型、１０例中型、１０例轻型，其中包含前述６例患者）血浆ＴＮＦα变化发现，血浆ＴＮＦα的水平与临床症状程度成正比，重型病例的血浆ＴＮＦα水平要高于轻型的（发热期重型ｎ＝７，３１．６３±１２．３６ｐｍｏｌ／Ｌ，ｖｓ轻型ｎ＝１０，１９．８９±５．９４ｐｍｏｌ／Ｌ，Ｐ＜０．０５），同一病例发病的不同时期，以低血压休克期升高最为明显。血浆ＴＮＦα水平与肾小球滤过功能损伤、肾近端和远端小管损伤程度密切相关。揭示ＴＶＦα可能是造成ＥＨＦ发病，特别是低血压休克和肾损害的重要介质。应用单抗等拮抗ＴＮＦα，有可能成为今后ＥＨＦ临床治疗中一个重要的措施。umor necrosis factor alpha (TNF-α)has been implicated as one of the majorpathological mediators during severe inflam-mation. This is supported by evidence thatTNF-α levels rise significantly during septicshock, and that anti-TNF antibodies havebeen shown to prevent the toxic effects ofgram negative bacteia.Since the clinicaltnanifestations of epidemic hemorrhaegicfever(EHF)have some similarities withthose of septicemia,TNF-α also may medi-ate some of the symptoms of EHF.In thisstudy, the expression of TNFa mRNA byperipheral blood mononuclear cells (PBMC)from 6 patients with EHF were examined.Patients were stratified according to the cri-teria developed by the National Ministry ofHealth:2 mild,2 moderate and 2 severe.Noendotoximia was found in these 6 patients.TNF-α mRNA was detected in 2 severe pa-tients and 1 moderate patients. More TNF-αmRNA abundance was found in patient dur-ing the hypotensive phase. TNF-α mRNAwas detectable in LPS stimulated PBMC butnot in the unstimulated PBMC in patientwith mild EHF.In parallel with the incre-ment of TNF-α mRNA expression byPBMC, there was increment of TNFa posi-tive PBMC in patients with EHF,and inparticular, in severe and moderate patientsduring the phase of hypotensive shock.There was also phenotypes evidence ofTNF-α expression by lymphocyte and renaltubular cell.To further define the role ofTNF-α in EHF,plasma level of TNF-α in 10severe, 10 moderate and 10 mild patientswere investigated,and the correlation of thelevel of plasma TNF-α with the severity ofdisease,the clinical course,and the degree ofrenal damage were studied. Plasma TNF-αlevel increased significantly in patients withEHF,especially in severe patients,as op-posed to those in normal controls.The de-gree of increment peaked in the hypotensiveshock phase.The level of plasma TNF-αwas correlat

关 键 词：流行性出血热 肿瘤坏死因子Α 病理 

分 类 号：R512.802[医药卫生—内科学]