严重脓毒症患者炎症因子的动态变化及预后意义  

Dynamic changes and prognostic slgniflcance of inflammatory factors in patients with severe sepsis

作　　者：温前宽[1] 李彦[1] 杨建萍[1] 魏冯宁[1] 孙力超[1] 王海峰[1] 练睿[1] 顾承东[1] 

机构地区：[1]中日友好医院急诊科,北京100029

出　　处：《中华急诊医学杂志》2015年第7期779-783,共5页Chinese Journal of Emergency Medicine

摘　　要：目的检测不同病情分级的脓毒症患者血清炎症细胞因子的质量浓度变化，探讨细胞因子与病情及预后的关系。方法收集2010年10月至2013年10月中日友好医院急诊科收治的严重脓毒症34例和脓毒性休克患者22例，分别于患者入院时、入院后6、24、72和168h5个时间点采静脉血检测细胞因子TNF-α，IL-6和PAF的质量浓度，另选51例健康成年人为对照组进行前瞻性研究。严重脓毒症和脓毒性休克的临床诊断依据《2012国际严重脓毒症和脓毒性休克诊治指南》的标准，排除既往患有恶性肿瘤、自身免疫性疾病、AIDS、年龄不满18岁和24h内死亡的患者。采用酶联免疫吸附法（ELISA）测定炎症细胞因子的质量浓度，组间比较采用方差分析；又根据患者28d转归分为存活组和死亡组，比较组间不同时间点各细胞因子的变化，分析其与病情和预后的关系。组间比较采用LSD—t检验。结果严重脓毒症组和脓毒性休克组的细胞因子在入院时明显高于对照组，TNF—α分别为（26．08±7．36）pg／mL、（54．14±13．56）pg／mL和（19．52±3．44）or／mL；IL-6分别为（39．52±9．52）pg／mL、（49．03±10．31）pg／mL和（20．46±6．39）pg／mL；PAF分别是（80．13±20．43）pg／mL、（135．5±23．45）pg／mL和（57，32±19．11）pg／mL，差异均有统计学意义（P〈0．05），脓毒性休克组细胞因子质量浓度在不同时间点均高于严重脓毒症组，差异具有统计学意义（P〈0．05）。死亡组细胞因子浓度在不同时间点均高于存活组，差异具有统计学意义（P〈0．05）。动态观察发现，各组TNF-α和IL-6的血清质量浓度峰值在入院后6h，PAF的血清质量浓度峰值在入院当时。随后呈动态下降趋势，各组动态变化曲线呈平行走势。结论脓毒症患者病情越重。相关细胞因子质量浓度越高。不同病情分级和预后的患者细胞因子的动态Objective To detect the change of the concentration of serum inilammatory cytokines of sepsis patients with different severity grades, and to explore the relationship between cytokines and severity as well as prognosis. Methods Twenty-two severe sepsis patients and 34 septic shock putients were collected from October 2010 to October 2013 at the China-Japan Friendship Hospital Emergency Department. Venous blood samples were collected to assay concentration of cytokines TNF-α, IL-6 and PAF at 5 intervals, when patients were admitted to hospital, 6 hours, 24 hours, 72 hours and 168 hours after admission. Besides, another 51 healthy adults were recruited as control group for comparison with patient group. The diagnosis of severe sepsis and septic shock were based on ＂2012 serious sepsis and septic shock treatment guidelines＂. Patients with history of malignant tumor, autoimmune diseases and AIDS were excluded, as well as patients under 18 years old and died within 24 hours. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the concentration of inflammatory cytokines, variance analysis was used for group comparison between groups; and patients were divided into survival group and death group according to the patient outcome in 28 days. The changes of cytokines at different intervals were compared and its relationship between the severity and prognosis were analyzed, and t test was used for comparison between groups. Results Concentrations of cytokines on admission of severe sepsis and septic shock group were significantly higher than those of the control group; TNF-α were （26. 08 ± 7.36） pg/mL, （54.14±13.56） pg/mLvs. （19.52±3.44） pg,/mL; IL-6were （39.52±9.52） pg/mL, （49.03±10.31） pg/mLvs. （20.46±6.39） pg/mL, PAF were （80.13±20.43） pg/mL, （135.5 ±23.45） pg/mL vs. （ 57.32 ± 19. 11 ） pg/mL, the differenees were statistically significant （ P 〈 0. 05 ） . The concentrations of cytokines in septic shock group were higher than those of severe sepsi

关 键 词：脓毒症 肿瘤坏死因子Α 白细胞介素6 血小板活化因子 动态变化 

分 类 号：R459.7[医药卫生—急诊医学]