多发伤患者外周血单个核细胞NF-κB活性变化及乌司他丁的保护作用  

Dynamic activity of NF - kB in multiple trauma patients and protective effects of Ulinastain

作　　者：周智强[1] 李能平[1] 顾永峰[1] 杨欣[1] 卢小兵[1] 丛建农 凌云[1] 唐江安[1] 袁晓燕[1] 王华[1] 

机构地区：[1]上海市浦东新区公利医院外科,200135

出　　处：《中国急救医学》2011年第10期913-916,共4页Chinese Journal of Critical Care Medicine

基　　金：上海市浦东新区卫生科技项目（No.PWRd2007-05）

摘　　要：目的 探讨多发伤患者早期外周血单个核细胞NF—xB活性变化及乌司他丁的保护作用。方法收集2008—01～2010—05急诊收治20—55岁的多发伤患者，将入选的多发伤患者随机分为多发伤对照组、乌司他丁治疗组。乌司他丁治疗组在创伤后12h内开始给予乌司他丁治疗，20万U溶于100mL生理盐水中静脉注射，以后每8h1次，连续7d。采集患者在入院时（0）、第1天、第2天、第3天、第4天及第7天外周静脉血。测定外周血单个核细胞NF—KB活性及血清TNF-a、IL-1、IL-6浓度。分析比较不同组患者实验室指标和临床指标的差异。结果多发伤患者创伤后第1天（24h）外周血单个核细胞NF—KB活性、血清IL-6、TNF-a浓度均最高，随后逐渐降低，至第3天（72h）后降至正常。乌司他丁治疗组单个核细胞NF—KB活性、血清IL-6、TNF-a浓度均较对照组降低，但差异无统计学意义。多发伤患者SIRS平均持续（10±3．5）d，乌司他丁治疗组平均持续（7±3．1）d，两组比较差异有统计学意义（t=2．31，P=0．029）。多发伤患者MODS平均持续（8．8±2．6）d，乌司他丁治疗组平均持续（5．6±2．7）d，两组差异有统计学意义（t=2．27，P=0．025）。结论多发伤患者早期单个核细胞NF—KB活性及血清前炎症细胞因子呈一过性升高。乌司他丁能缩短多发伤患者SIRS、MODS持续时间，但未发现能显著降低外周血单个核细胞NF—KB活性。Objective To investigate dynamic activity of NF - KB in multiple trauma patients in the early period and protective effects of Ulinastain. Methods Selecting multiple trauma patients who were admitted to emergency department and were 20 -55 years old from January 2008 to May 2010, all enrolled patients were assigned randomLy to control group and Ulinastain group. The patients of Ulinastain group received 200 000 U of Ulinastain with 100 mL of normal saline, every 8 hours for 7 days. NF- KB activity in monocytes and level of TNF- a,IL- 1 ,IL-6 on admission（d0）, dl, d2, d3, d4, d7 in serum were measured. Data were compared and analyzed between different groups. Results NF - KB activity in monocytes and level of TNF -a, IL - 1, IL - 6 of multiple patients reached peak at 24 h after trauma, and decreased gradually, and became normal at 72 hour after trauma. NF - KB activity and level of TNF - a, IL - 1, IL - 6 in Ulinastain group were lower than control group, but there were no significant difference between the two groups. The mean time of persisting SIRS and MODS were （7 ±3.1 ） days and （ 10 ±3.5） days in Ulinastain group and control group respectively, and showed significant difference. Conclusion NF - KB activity in monocytes and level of inflammatory cytokines in multiply injured patients increased transiently in the early period of trauma. Ulinastain may shorten SIRS, MODS time, but doesnt show the ability of decreasing the activity of NF - KB.

关 键 词：创伤 乌司他丁 核转录因子(NF—KB) 

分 类 号：R512.62[医药卫生—内科学]