重度吸入性损伤患者气道呼出气冷凝液中多种细胞因子水平变化及临床意义  

Changes and clinical significance of multiple cytokines in exhaled breath condensate in patients with severe inhalation injury

作　　者：刘云峰 张勇[1] 丁盛 孙燃 刘小俊 苏建东[1] 孙炳伟 Liu Yunfeng;Zhang Yong;Ding Sheng;Sun Ran;Liu Xiaojun;Su Jiandong;Sun Bingwei(Department of Burns and Plastic Surgery,Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Suzhou 215002,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)烧伤整形科,江苏苏州215002

出　　处：《中华危重病急救医学》2023年第8期818-822,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金(U21A20370);江苏省苏州市科技计划项目(SKJY2021117)。

摘　　要：目的:探讨重度吸入性损伤后气管切开患者气道呼出气冷凝液(EBC)中多种细胞因子水平变化及其临床意义。方法:采用前瞻性研究方法,选择2021年5月至2022年8月南京医科大学附属苏州医院烧伤整形科收治的32例烧伤合并重度吸入性损伤患者;选择同期20例健康志愿者作为对照。收集患者伤后12 h EBC,同时收集健康对照者样本,采用液相芯片技术测定EBC中27种细胞因子水平,其中包括肿瘤坏死因子-α(TNF-α)和白细胞介素(IL-1β、IL-6、IL-8、IL-10、IL-17)6种炎症细胞因子;收集患者伤后12 h血浆,同时收集健康对照者血浆,采用液相芯片技术检测上述6种炎症细胞因子水平,分析其与EBC中含量的差异;于患者伤后12 h及3、7、14、21 d收集血浆和EBC,采用酶联免疫吸附试验(ELISA)检测TNF-α水平。结果:最终32例患者纳入分析,烧伤总面积(40±16)%总体表面积(TBSA);入院时间为伤后(4.2±2.3)h。①EBC中27种细胞因子:重度吸入性损伤患者巨噬细胞炎症蛋白-1β(MIP-1β)、IL-6、IL-5、IL-2、IL-1β、IL-8、IL-10、IL-15、IL-9、γ-干扰素(IFN-γ)、IL-1受体拮抗剂(IL-1ra)、TNF-α、嗜酸粒细胞趋化因子(Eotaxin)、碱性成纤维细胞生长因子(bFGF)、血小板衍生生长因子-BB(PDGF-BB)、干扰素诱导蛋白-10(IP-10)、巨噬细胞趋化蛋白-1(MCP-1)、粒细胞集落刺激因子(G-CSF)18种细胞因子水平均较健康对照者明显升高,其中Eotaxin在健康对照者EBC中未检出;粒-巨噬细胞集落刺激因子(GM-CSF)、趋化因子配体5(CCL5/RANTES)、IL-13、IL-4、MIP-1α5种细胞因子在重度吸入性损伤及健康对照者EBC中均未检出;重度吸入性损伤患者EBC中血管内皮生长因子(VEGF)和IL-12 p70较健康对照者轻度下降,IL-7和IL-17轻度升高,但差异均无统计学意义。②血浆中6种炎症细胞因子:重度吸入性损伤患者IL-6和IL-8水平均较健康对照者明显升高〔IL-6(ng/L):18.51(10.87,26.21)比0.22(0.10,0.36),ILObjective To investigate the changes and clinical significance of multiple cytokine levels in exhaled breath condensate(EBC)in patients undergoing tracheotomy with severe inhalation injury.Methods A prospective study was conducted.A total of 32 patients with severe burn combined with severe inhalation injury admitted to the department of burns and plastic surgery of Affiliated Suzhou Hospital of Nanjing Medical University from May 2021 to August 2022 were enrolled.Twenty healthy volunteers from the same period were served as controls.EBC of patients at 12 hours after burn and the samples of healthy controls were collected.The levels of 27 cytokines in EBC,including tumor necrosis factor-α(TNF-α)and interleukins(IL-1β,IL-6,IL-8,IL-10,and IL-17),were determined by liquid phase chip technology.Meanwhile,plasma of patients at 12 hours after burn and the plasma of volunteers were collected,and the levels of inflammatory cytokines were detected by liquid chip technology,and the differences between the levels in plasma and those in EBC were analyzed.Plasma and EBC of patients with aspiration injury were collected at 12 hours and 3,7,14 and 21 days after burn,and TNF-αlevels were determined by enzyme-linked immunosorbent assay(ELISA).Results Finally,32 patients were enrolled,and the total burned area was(40±16)%of total body surface area(TBSA).The time of admission was(4.2±2.3)hours after injury.①Twenty-seven cytokines in EBC:18 kinds of cytokines including macrophage inflammatory protein-1β(MIP-1β),IL-6,IL-5,IL-2,IL-1β,IL-8,IL-10,IL-15,IL-9,interferon-γ(IFN-γ),IL-1 receptor antagonist(IL-1ra),TNF-α,chemotactic factor for eosinophil(Eotaxin),basic fibroblast growth factor(bFGF),platelet derived growth factor-BB(PDGF-BB),interferon-inducible protein-10(IP-10),monocyte chemoattractant protein-1(MCP-1),granulocyte colony-stimulating factor(G-CSF)were significantly increased in patients with severe aspiration injury compared with health controls.Eotaxin was not detected in EBC of healthy controls.Five cytokines

关 键 词：吸入性损伤 气管切开 呼出气冷凝液 细胞因子 

分 类 号：R644[医药卫生—外科学]