ICU重症患者TNFα和CRP测定应用探讨.docVIP

ICU重症患者TNFα和CRP测定应用探讨 　　【摘要】 目的 通过定量测定ICU危重患者肿瘤坏死因子-α（TNF-α）和C-反应蛋白（CRP）的浓度，探讨两者的临床意义。方法 将100例危重患者，根据APACHEⅡ评分系统分为A组（25分）20例，按病情分为MODS组38例,非MODS组62例。正常对照组为体检健康者50例。采集每组患者血标本，采用酶联免疫吸附法（ELISA）检测标本TNF-α、cTnI和CRP浓度。结果 危重患者的TNF-α和CRP浓度均高于健康体检组（P0.01）；不同APACHEⅡ评分组之间TNF-α和CRP差异有统计学意义（P0.05或0.01）；MODS组患者的TNF-α和CRP值明显高于非MODS组（P0.01）。结论 危重患者TNF-α、CRP和APACHEⅡ评分有较好的相关性，病情越重，两者的值越高。因此，可用于评价危重患者病情严重程度，对于预测预后有一定的临床意义。 　　【关键词】 肿瘤坏死因子-α； C-反应蛋白； APACHEⅡ评分； 重症医学 　　The discussion of ICU patients with TNFα and CRP levels MA Jin-luan，LI Wen-qiang，SUN Hui， ZHANG Huan-yun，SHI Ji-kui.Jining Medical College afflicted Jining First Peoples Hospital,Jining 272100,China 　　【Abstract】 Objective To explore the clinical significances of tumor necrosis factor-α （TNF-α） and C-reactive protein （CRP） of critically ill patients in ICU.Methods according to APACHEⅡ score system, 100 critically ill patients were divided into A group: 25 points of 20 cases; all cases were divided into MODS group 38 cases, non-MODS group 62 cases. Fifty normal healthy subjects were control group.Results The results showed that critically ill patients with TNF-α and CRP concentrations were higher than healthy people group （P0.01）, TNF-α and CRP concentrations were significantly different （P0.05 or 0.01 ） among different groups with APACHEⅡ scores; TNF-α and CRP of MODS group were significantly higher than non-MODS groups （P0.01）.Conclusion Critically ill patients with TNF-α and CRP have good correlation with APACHEⅡ score，the more serious, the higher concentrations of the TNF-α and CRP. Therefore, TNF-α and CRP can be used to evaluate the severity of critically ill patients, also to predict prognosis of clinical patients. 　　【Key words】 TNFα; CRP; APACHEⅡ score system; ICU 　　危重患者往往存在SIRS或MODS，炎症介质和应激蛋白在SIRS和MODS的发生和发展过程中起着重要的作用，其中TNF-α是应激时重要的促炎介质，CRP是体内重要的应激蛋白。大量动物实验和临床研究表明，炎症介质已成为预测MODS的标志［1,2］。本文通过测定危重患者血浆TNF-α和CRP水平并结合急性生理学及慢性健康状况Ⅱ（APACHEⅡ）评分系统［3］，探讨危重病患者血浆TNF-α和CRP水平变化及其临床意义，为判断患者危重程度及预后开辟新的途径。 　　1 资料与方法 　　1.1 一般资