肾综合征出血热10种炎性介质的动态变化及临床意义  

The dynamic variation and the clinic significance of 10 phlogogenic mediators in hemorrhagic fever with renal syndrome

作　　者：孙水林[1] 郑晓君[1] 陈家鸰[2] 徐贞秋[2] 钟恢海[1] 刘林华[1] 

机构地区：[1]南昌大学第二附属医院感染性疾病科,330006 [2]南昌大学附属感染病医院,330001

出　　处：《国际流行病学传染病学杂志》2008年第4期229-232,共4页International Journal of Epidemiology and Infectious Disease

基　　金：南昌市科委基金资助项目（2004096）

摘　　要：目的了解10种炎性介质在肾综合征出血热病程中的动态变化及作用机制。方法前瞻性选取肾综合征出血热病例53例，其中轻型9例，中型16例，重型15例，危重型13例。按病期采集血清样本，血液透析（血透）治疗时透析前后采集血清样本，20例正常人血清样本作对照；用ELISA法检测上述样本中的炎性介质（TNF-α、IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12、IL-15和IFN-α）；按病期、病型和血透干预三个层次进行分析。结果TNF-α、IL-1β、IL-4、IL-6、IL-8、IL-10、IL-12在发热期即明显高于对照组，在低血压少尿期达高峰（P〈0．01），IFN—α水平在各期均低于对照组（P〈0．01）；多数炎性介质水平在重症组高于轻症组（P〈0．01）；血透后大部分炎性介质有明显下降（P〈0．01）。结论10种炎性介质均参与肾综合征出血热发病的炎症过程；促炎与抗炎介质分泌失衡，TNF-α、IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12和IL-15分泌过量，导致明显的全身炎症反应，分泌量与炎症损害呈正相关；血清IFN-α水平低下，抗病毒作用有限；血透能显著减少患者血清中的炎性介质，减轻炎症损害，缩短病程，并改善预后。Objective To investigate the variation and the clinic significance of 10 serum phlogogenic mediators in hemorrhagic fever with renal syndrome（HFRS）. Method Prospectively selected 53 patients with HFRS （9 mild cases, 16 mederate cases, 15 severe cases and 13 dangerous cases）. Blood samples were collected at different stages of the disease, as well as pre-treatment and post-treatment for patients who received hematodialysis, and 20 healthy adults as a control group. Serum levels of phlogogenic mediators （TNF-α, IL-1β, IL-2, IL-d, IL-6, 1L-8, IL-10, IL-12, IL-15 and IFN-α） were detected by ELISA then compared and analyzed according to three factors： stage, pattern and intervention of hematodialysis. Results Compared with control group, serum levels of TNF-α,IL-1β,1L-d,IL-6,IL-8,IL-10 and IL-12 in HFRS cases significantly increased in febrile stage with the peak values in hypotensive-oliguric stages（ P 〈 0.01 ）. Serum levels of IFN-α were lower than control group in all stages（ P 〈 0.01 ）. Serum levels of some phlogogenic mediators in severe group were higher than in mild group （ P 〈 0.01）. Serum levels of some phlogogenic mediators started to decrease after treatment with hematodialysis （P 〈 0.01 ）. Conclusions 10 serum phlogogenic mediators all participate in the inflammation process of HFRS. The pro-inflammatory and anti-inflammatory are unbalanced excretion. The over-excretion of TNF-α, IL-1β,IL-2,IL-d,IL-6,IL-8,IL-10,IL-12 and IL-15 results in the inflammation response. There is a positive correlation between the excretion and the inflammation damage. The lower level of IFN-α can＇ t cause enough anti-virus effect. The hematedialysis can significantly decrease the serum phlogogenic mediator in patient＇s serum, relieve the inflammation damage.

关 键 词：肾综合征出血热 炎性介质 作用机制 

分 类 号：R512.8[医药卫生—内科学] R562.25[医药卫生—临床医学]