重度创伤患者细胞因子变化及临床意义.docVIP

重度创伤患者细胞因子变化及临床意义【摘要】 目的 探讨重度创伤患者细胞因子的变化及临床意义。方法 采用ELISA法检测48例重度创伤患者入院时、入院后第12 h， 3、7、14 d(ISS≥10)血中IL-4(IL-4)、IL-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平变化，并与正常健康人进行比较。结果 多发性创伤后血中IL-4、IL-6及 TNF-α水平早期即显著高于正常对照组(P0．05)，于伤后第3天后达到高峰(P0．01)，随后逐渐降低，于伤后2周仍显著高于正常。多发性创伤IL-4、IL-6及 TNF-α水平升高幅度与ISS评分呈显著正相关。结论 动态观察多发性创伤患者细胞因子活性的变化有助于病情的评估及预后判断。 【关键词】重度创伤；IL-4；IL-6；肿瘤坏死因子-α Changes of cytokine index in patients with severe trauma and its clinical significance HOU Wen-yuan.The Chinese traditinal medicine hospital of Linyi,Linyi 276000 China 【Abstract】 Objective To study the changes of cytokines in patients with severe trauma and its clinical significance.Methods The concentration of the IL-4,IL-6 and TNF-α was measured by enzyme linked immunosorbent assay(ELISA)in 48 patients with severe trauma at admission and 12 hours， 3，7 and 14 days,and were compared with those in the healthy control group simultaneously.Results The serum IL-4,IL-6 and TNF-α in patients with severe trauma were shown to be significantly higher than those in the control group.The IL-4,IL-6 and TNF-α increased at the early stage and reached the peak at 3 days and subsequently decreased gradually in 2 weeks after trauma.The ISS scores of patients were positively correlated with the peaks of IL-4,IL-6and TNF-α.Conclusion Investigating the changes of cytokines in patients with severe trauma would contribute to evaluate the patient’s condition and judge the prognosis of this disease. 【Key words】Severe trauma；IL-4；IL-6；TNF-α 重度创伤是较为严重的创伤，并足以威胁或加重整体伤情。它是急救中心常见病之一，其病情危重，死亡率高。导致这一结果的原因当然很多。而近年来的研究表明，重度创伤的发展以及全身性炎症反应综合征(SIRS)、多器官功能障碍综合征（MODS）等并发症的发生，与机体的一些炎症介质在受伤后的变化密切相关，特别是同TNF-α及一些白细胞介素等细胞因子的产生密不可分。本研究观察了48例重度创伤患者血清中一些细胞因子的变化，意在明确重度创伤后不同时段外周血中的IL-4、IL-6及肿瘤坏死因子-α(TNF-α)等细胞因子水平的动态变化，旨在探讨它们在创伤后病情发展中的作用，现报告如下。 1 资料与方法 1．1 一般资料 重度创伤系指合并2个以上部位或脏器、系统的损伤；受伤原因主要为车祸伤、高处坠落伤等较为复杂的伤情，AIS-SS评分≥ 16分。本组重度创伤患者48例，男32例，女16例，年龄18~65岁，平均(38．2±9．8)岁。其中颅脑损伤16例，胸外伤8例，腹部伤14例，四肢伤10例。排除伤前合并其他系统疾病、恶性肿瘤、服用激素、免疫抑制剂、放化疗史患者。对照组20例，为青壮年健康体检人