热射病早期肠屏障功能损害与炎症反应因子的相关性  

The analysis of relationship between intestinal barrier function injury and inflammatory cytokines in early heat stroke patients

作　　者：田锐[1] 谢云 杜江[1] 金卫[1] 陆健[1] 谢晖[1] 朱献[1] 程瑞杰 吕慧 袁成斌 王瑞兰[1] Tian Rui;Xie Yun;Du Jiang;Jin Wei;Lu Jian;Xie Hui;Zhu Xian;Cheng Ruijie;LYU Hui;Yuan Chengbin;Wang Ruilan(Department of ICU,Shanghai General Hospital,Shanghai 201620,China)

机构地区：[1]上海市第一人民医院急诊危重病科,201620

出　　处：《中华重症医学电子杂志》2018年第4期333-337,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：目的通过研究重症中暑热射病患者肠屏障功能、炎症因子水平、免疫细胞变化规律,以判断其对临床预后的作用。方法收集上海市第一人民医院重症医学科2017年6至8月收治的14例重症中暑热射病患者,根据发病至就诊时间是否大于3 h将其分为早期就诊组(7例)和晚期就诊组(7例),监测其肠屏障功能、炎症因子水平、免疫细胞水平等,并进行受试者工作特征(ROC)曲线分析,比较2组肠屏障功能、炎症因子、免疫细胞等指标差异,评价其在热射病监测中的价值。结果晚期就诊组比早期就诊组入院平均动脉压低[(73.28±7.49)mm Hg vs(90.23±16.25)mm Hg,P=0.028,1 mmHg=0.133 kPa],急性生理学与慢性健康状况评分系统(APACHEⅡ)评分、病死率、白介素(IL)-2受体、IL-6、IL-8、IL-10高[APACHEⅡ评分:(25.71±3.04)分vs (20.14±2.91)分,P=0.004;病死率:28.6%vs 0,P=0.000;IL-2受体:(738.00±197.40)U/ml vs (159.80±67.79)U/ml,P=0.025;IL-6:(380.10±401.90)pg/mlvs(6.72±3.38)pg/ml,P=0.049;IL-8:(2850.51±3512.88)pg/mlvs(33.35±28.27)pg/ml,P=0.023;IL-10:(497.20±470.60)pg/mlvs(41.55±66.47)pg/ml,P=0.043],差异具有统计学意义(均P <0.05);IL-10对肝功能损伤判断的ROC曲线下总面积为0.893,在最佳诊断界点为92.5时敏感度和特异度分别为71.4%和100.0%。结论热射病发病3 h内就诊预后较好,IL-6是判断重症中暑热射病临床危重程度的良好指标,IL-10可能可以作为热射病预后肝功能损伤的预警指标。ObjectiveTo investigate observe intestinal barrier function injury in early heat stroke patients,and explore its correlation with in？ammatory cytokines. Methods14 patients diagnosed with heat stroke were divided into early group （7 cases） or late group （7 cases） by whether the onset of heat stroke was more than 3 h. The blood from each patients was collected for detection of immune cells, in？ammatory cytokines and intestinal barrier function. ResultsMean arterial pressure was significantly higher in late group [（73.28±7.49） mmHg vs （90.23±16.25） mmHg, P=0.028, 1 mmHg=0.133 kPa]. APACHE Ⅱ scores, mortality rate, level of interleukin-2 receptor, interleukin-6, interleukin-8 and interleukin-10 were signi？cantly higher in late group [APACHE Ⅱ scores （25.71±3.04） scores vs （20.14±2.91） scores, P=0.004; mortality： 28.6% vs 0, P=0.000; IL-2 receptor： （738.00±197.40） U/ml vs （159.80±67.79） U/ml, P=0.025; IL-6： （380.10±401.90） pg/ml vs （6.72±3.38） pg/ml, P=0.049; IL-8： （2850.51±3512.88） pg/ml vs （33.35±28.27） pg/ml, P=0.023; IL-10： （497.20±470.60） pg/ml vs （41.55±66.47） pg/ml, P=0.043]. The total area under the ROC curves of interleukin-10 for liver function damage was 0.893. Interleukin-10 at a level of 92.5 was with best diagnostic accuracy, with sensitivityof 71.4%, and speci？city of 100.0%. ConclusionHeat stroke within 3 hours of onset had a better prognosis. IL-6 is a good indicator for clinical severity in heat stroke. IL-10 can be used as an early warning marker of liver dysfunction in heat stroke.

关 键 词：热射病 白介素-6 白介素-8 白介素-10 肠黏膜屏障 全身炎症反应 

分 类 号：R594.12[医药卫生—内科学]