肿瘤坏死因子及其受体与血磷水平的关系及预后价值  

Soluble tumor necrosis factor receptor correlate with plasma phosphate levels and early predict the outcome

作　　者：杨晓军[1] 王晓红[1] 曹相原[1] 

机构地区：[1]宁夏医学院附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2005年第10期661-663,共3页Ningxia Medical Journal

摘　　要：目的探讨危重病人肿瘤坏死因子-α(TNF-α)及其可溶性受体I(sTNFRI)、应激激素、蛋白质代谢与血磷的关系及其预后判断价值。方法前瞻性研究2003年6月-2003年12月47例危重病人按随访结果分为存活组和死亡组,同时设立正常对照组(15例)。所有研究对象检测血中TNF-αs、TNFRI、应激激素、营养指标及血磷水平,并进行相关性分析。结果(1)危重病患者血磷值明显低于正常对照组(P<0.001),sTNFRI、TNF-α、皮质醇、胰高血糖素均显著高于正常对照组(P均<0.01)。(2)危重病死亡组APACHEII评分s、TNFRI、皮质醇、胰高血糖素均高于存活组(P<0.01或P<0.05),但TNF-α、前白蛋白(PA)、转铁蛋白(TF)、白蛋白(ALB)等两组间无显著性差异,而血磷值明显低于存活组(P<0.01)。(3)APACHEII评分s、TNFRI、TNF-α与血磷水平相关(P<0.01或P<0.05),皮质醇、胰高血糖素、营养指标与血磷水平均无相关关系(P均>0.05)。(4)以危重病预后为因变量的Logistic回归分析示仅APACHEII评分独立与危重病预后相关。结论血中TNF-αs、TNFRI介导了危重病低磷血症的发生,低磷血症可作为疾病严重程度的判断指标。Objective To investigate the relationship between TNF- α, soluble tumor necrosis factor receptor Ⅰ （s＇INFRI）, stress hormones, protein catabolism and correlate with plasma phosphate , to detemaine the value of above indicators in predicting outcome of critical ill. Methods 47 critically ill patients were divided into survivor group and nonsurvivor group according to the results of following up from June 2003 to December 2003, 15 healthy volunteers were control group. The blood levels of TNF -α, sTNFRI, stress hormones, nutritional indicators and phosphate levels were measured in all subjects studied, and then we analyzed the relatiortship between above indicators. Results （ 1 ） Plasma phosphate levels were significantly lower in critically ill patients when compared with control group（ P 〈 0.001 ）, Concentrations of TNF - α, sT- NFRI, cortisol and glucagon were significantly higher in critically ill patients（ P 〈 0.01 ）. （2）Nonsurvivors in critically ill patients had higher APACHEII scores and higher concentrations of sTNFRI, cortisol and glucagon than survivors（ P 〈 0.01or P 〈 0.05 ）, but there were no differences in TNF- α, PA, TF and ALB levels between the two group, Plasma phosphate were significantly lower in nonsurvivors（ P 〈 0.01 ）. （3） APACHEII scores, sTNFRI,TNF- α correlated well with the levels of plasma phosphate（ P 〈0,01 or P 〈0,05） .The levels of cortisol, glucagon and nutritional indicators did not correlate with plasma phosphate levels（ P 〉 0.05）. （4）Logistic regression analysis with hospital mortality as dependent variable indicated that only APACHEII scores and sTNFRI were still related to the outccrne of critically ill patients. Conclusion TNF -α,sTNFRI may initiate in critically ill patients, hypophosphatemia can predict severity of critical illness.

关 键 词：危重病 肿瘤坏死因子-α 肿瘤坏死因子可溶性受体Ⅰ 低磷血症 

分 类 号：R446.6[医药卫生—诊断学]