脓毒症患者促炎/抗炎反应和下丘脑-垂体-肾上腺轴变化与脓毒性休克预后的关系  

The relationship of prognosis of septic shock with pro-/anti-inflammatory response and HPA axis profile in patients with severe sepsis

作　　者：于泳浩[1] 崔乃强 傅强 李君[1] 

机构地区：[1]天津医科大学总医院麻醉科,天津300052 [2]天津南开医院ICU

出　　处：《中华急诊医学杂志》2003年第7期470-473,共4页Chinese Journal of Emergency Medicine

基　　金：天津市科委科研基金 ( 98113 411)

摘　　要：目的　探讨严重脓毒症患者发病早期促炎和抗炎性因子 (TNF α、IL 10、PGE2 )以及HPA轴激素 (ACTH、GC、β EF)水平及其与预后的关系和对血流动力学的影响　 方法　测定 2 0例符合严重脓毒症诊断的腹腔感染患者入院和入院 4 8h各因子和激素水平 ,18例健康成人为对照 ,并将死亡与存活组及休克和非休克组间进行比较。结果　除TNF α、IL 10明显下降外 ,观察组各指标均明显高于对照组。死亡组TNF α、IL 10和PGE2 、ACTH和GC明显高于存活组 ,TNF α∶IL 10比值明显下降并在 4 8h后更明显。休克组TNF α、PGE2 、ACTH与 β ET明显高于非休克组 ,GC却明显低于后者 ,ACTH∶GC比值增高。 结论　严重脓毒症患者早期抗炎反应优势与疾病的严重程度和不良预后有关 ,高水平的PGE2 和HPA轴激活可能与此有关。Objective To investigate the levels of pro /anti inflammatory cytokines and HPA axis hormones in patients with severe sepsis and their prognostic value and influence on hemodynamics.Methods Blood concentration of TNF α,IL 10,PGE 2,ACTH,glucocorticoid (GC)and β endorphin were measured in 20 patients with severe intra abdominal infection,according to the criteria of severe sepsis,on admission and 48 h after admission,and compared between survivors and non survivors,shock and non shock groups.Eighteen healthy individuals served as control group.Results Level of all cytokines and hormones were significantly elevated in patients except the ratio of TNF α to IL 10.Elevated TNF α,IL 10,PGE 2,ACTH and GC were associated with death and the ratio of TNF α to IL 10 was lower in non survivors group.High levels of TNF α,PGE 2 ACTH and β endorphin were detected in septic shock group with lower level of GC and elevated ratio of ACTH to GC.Conclusion The early overproduction of anti inflammatory cytokines in patients with severe sepsis resulted from intra abdominal infections were sustained and correlated with severity and fatal outcome.The over activity of HPA axis and high level of PGE 2 might be the reason.The early relative adrenal insufficiency and hyperinflammatory cytokines might predict early septic shock.

关 键 词：脓毒症患者 促炎/抗炎反应 下丘脑 垂体 肾上腺轴 脓毒性休克 腹腔内感染 

分 类 号：R631[医药卫生—外科学]