促炎及抗炎细胞因子变化在肾综合征出血热发病中作用.docVIP

促炎及抗炎细胞因子变化在肾综合征出血热发病中作用 　【摘要】 目的 研究肾综合征出血热促炎与抗炎细胞因子变化在其发病中的作用。方法 35例患者(轻症组19例，重症组16例)按病期采血，分别用ELISA和放射免疫法检测ICAM-1、E-选择素、L-选择素、TGFβ-1、IFNγ、TNFα、IL-1β、IL-2、IL-4、IL-10等细胞因子，并同期检测血小板和肾功能。结果 从发热期至多尿期，血清TNFα、IL-1β、IFNγ、IL-2、E-选择素、L-选择素和ICAM-1水平均高于对照组，P＜0.05～0.01，而IL-4、TGFβ-1则显著降低，血清IL-10虽有所增加，但其增幅远比IFNγ为低，以致IFNγ/IL-10比值显著增高；TNFα、INFγ与BUN呈一致性变化趋势，而与血小板变化趋势相反。结论 肾综合征出血热发病过程中存在着促炎与抗炎细胞因子的失衡，这种失控性炎症反应是引起毛细血管渗漏和多器官功能障碍综合征的主要机制。合理补液、适量使用免疫调节剂，尽快恢复促炎与抗炎的平衡，可望改善本病的预后。 【关键词】 肾综合征出血热；细胞因子；E-选择素；L-选择素；转化生长因子β-1 Changes of pro-and anti-inflammatory cytokines and their pathogenic significance in hemorrhagic fever with renal syndrome 【Abstract】 Objective The aim of this study is to investigate the changes of serum pro-and anti-inflammatory cytokines and their pathogenic significance in hemorrhagic fever with renal syndrome(HFRS).Methods Serum levels of E-selectin、L-selectin、ICAM-1、TGFβ-1、IFNγ、TNFα、IL-1β、IL-2、IL-4 and IL-10 were detected by ELISA and radioimmunoassay respectively in 35 HFRS patients (19 moderate type，16 severe type) at different stages.Meanwhile blood urea nitrogen(BUN) and platelet count were examined synchronouslly.Results In HFRS cases from febrile stage to polyuric stage，serum levels of TNFα、IL-1β、IFNγ、IL-2、E-selectin、L-selectin and ICAM-1 were significantly increased as compared with control group(P＜0.05～0.01)，on the contrary， serum IL-4 and TGFβ-1 were significantly decreased and the IFNγ/IL-10 ratio was remarkablely elevated at the same time， though serum IL-10 level was higher than normal values.The curves of TNFα and INFγ were consistent with the changes of BUN，but were contrary to that of blood platelet count.Conclusion In the course of HFRS，the release of pro-inflammatory cytokines significantly exceeded over that of anti-inflammatory cytokines which would contribute to the pathogenesis of capillary leakage and multiple organ dysfunction syndrome(MODS). So that reasonable replacement of fluid and the use of immunoregulators to restore pro-and anti-inf