全身炎症反应综合征患儿血清内毒素与脂多糖结合蛋白脂多糖受体及肿瘤坏死因子-α的检测分析  

The investigation of LPS,LBP/CD14 and TNF-α in children with systemic inflammatory response syndrome

作　　者：程亚颖[1] 孙东明[2] 井丽娟[1] 尹建英[1] 

机构地区：[1]河北省人民医院儿科,河北石家庄050051 [2]河北省职工医学院附属医院儿科,河北保定071000

出　　处：《中国实用儿科杂志》2007年第3期208-211,共4页Chinese Journal of Practical Pediatrics

基　　金：河北省卫生厅科研基金课题(编号02035)

摘　　要：目的观察全身炎症反应综合征(SIRS)患儿血内毒素、脂多糖结合蛋白(LBP)、脂多糖受体(sCD14)及肿瘤坏死因子-α(TNF-α)水平的变化,探讨内毒素、LBP/CD14系统及TNF-α在SIRS发病中的作用以及与病情严重程度的关系。方法2000-09—2004-09对河北省人民医院儿科就诊的62例SIRS患儿分别采用鲎试剂动态比浊定量测定法、酶联免疫试验进行血内毒素、LBP、sCD14及TNF-α的定量测定,并对部分患儿进行动态观察。结果SIRS组内毒素、LBP、sCD14的水平均明显高于健康对照组,多器官功能障碍综合征(MODS)组明显高于非MODS组,且LBP、sCD14的质量浓度均随内毒素水平升高而升高,两者呈显著正相关。动态研究发现,恶化后内毒素、LBP、sCD14及TNF-α水平明显高于恶化前,且TNF-α分别与LBP和sCD14呈显著正相关。将患儿血sCD14均值在不同范围进行分组比较发现,随sCD14水平的升高,SIRS患儿合并MODS的例数增多,病死率亦随之上升。结论全身炎症反应时内毒素血症可能是刺激机体合成和释放LBP、CD14的重要因素之一,而LBP、CD14又可增敏内毒素效应,进一步刺激机体产生大量炎症因子,介导组织损伤。而且,sCD14水平与MODS的发生、发展密切相关,动态监测其变化对SIRS患儿的病情转归有一定的预警意义。Objective This investigation had measured the concentration of LPS,LBP,sCD14 and TNF-α in patients with SIRS and compared with healthy children, to clarify the role of LPS, LBP/sCD14 and TNF-α in the pathogenesis of SIRS. Methods Venous blood from all the cases were collected. LPS was determined by limulus reagent kinetic turbidimetric assay, LBP,sCD14 and TNF-α were determined by ELISA method. Some patients with SIRS were made following observation. Results The concentration of LPS, LBP, sCD14 in the patients with SIRS were much higher than the healthy children, and much higher in the MODS than the case not with MODS. Following the increase of concentration of LPS, the level of LBP and sCD14 increased accordingly, which show positive correlation. Dynamic study findings that the level of LPS, LBP, sCD14 and TNF-α were increased obviously with patients＇condition got worse,furthermore, it shown positive correlation obviously between TNF-α and LBP or sCD14. The study had found that the cases complicating MODS and the mortality increased following the increase of concentration of sCD14. Conclusion Exdomin＇ation may be one of factors that organ- ism released LBP and CD14 stimulated by LPS in SIRS,and LBP, CD^4 can addable the effect of LPS,than cause tissue damage by muhipul inflammatory factors. Furthermore, the content of sCD14 is closely correlation with the development of MODS, dynamic monitoring the concentration of sCD14 could make prognosis of SIRS

关 键 词：全身炎症反应综合征 内毒素 脂多糖结合蛋白 脂多糖受体 肿瘤坏死因子-Α 

分 类 号：R72[医药卫生—儿科]