CAJ | 학술논문

目的了解10种炎性介质在肾综合征出血热病程中的动态变化及作用机制.方法前瞻性选取肾综合征出血热病例53例,其中轻型9例,中型16例,重型15例,危重型13例.按病期采集血清样本,血液透析(血透)治疗时透析前后采集血清样本,20例正常人血清样本作对照;用ELISA法检测上述样本中的炎性介质(TNF-α、IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12、IL-15和IFN-α);按病期、病型和血透干预三个层次进行分析.结果 TNF-α、IL-1β、IL-4、IL-6、IL-8、IL-10、IL-12在发热期即明显高于对照组,在低血压少尿期达高峰(P＜0.01),IFN-α水平在各期均低于对照组(P＜0.01);多数炎性介质水平在重症组高于轻症组(P＜0.01);血透后大部分炎性介质有明显下降(P＜0.01).结论 10种炎性介质均参与肾综合征出血热发病的炎症过程;促炎与抗炎介质分泌失衡,TNF-α、IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12和IL-15分泌过量,导致明显的全身炎症反应,分泌量与炎症损害呈正相关;血清IFN-α水平低下,抗病毒作用有限;血透能显著减少患者血清中的炎性介质,减轻炎症损害,缩短病程,并改善预后.
목적 료해10충염성개질재신종합정출혈열병정중적동태변화급작용궤제.방법 전첨성선취신종합정출혈열병례53례,기중경형9례,중형16례,중형15례,위중형13례.안병기채집혈청양본,혈액투석(혈투)치료시투석전후채집혈청양본,20례정상인혈청양본작대조;용ELISA법검측상술양본중적염성개질(TNF-α、IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12、IL-15화IFN-α);안병기、병형화혈투간예삼개층차진행분석.결과 TNF-α、IL-1β、IL-4、IL-6、IL-8、IL-10、IL-12재발열기즉명현고우대조조,재저혈압소뇨기체고봉(P＜0.01),IFN-α수평재각기균저우대조조(P＜0.01);다수염성개질수평재중증조고우경증조(P＜0.01);혈투후대부분염성개질유명현하강(P＜0.01).결론 10충염성개질균삼여신종합정출혈열발병적염증과정;촉염여항염개질분비실형,TNF-α、IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12화IL-15분비과량,도치명현적전신염증반응,분비량여염증손해정정상관;혈청IFN-α수평저하,항병독작용유한;혈투능현저감소환자혈청중적염성개질,감경염증손해,축단병정,병개선예후.
Objective To investigate the variation and the clinic significance of 10 sirum phlogogenic mediators in hemorrhagic fever with renal syndrome(HFRS).Method Prospectively selected 53 patients with HFRS(9 mild cases,16 moderate caseg,15 severe cases and 13 datlgerous cases).Blood samples were collected at different stages of the disease,as well as pre-treatment and post-treatment for patients who received hematodialysis.and 20 healthy adults as a control group.Serum levels of phlogogenic medlators(TNF-α,IL-1β,IL-2,IL-4,IL-6,IL-8,IL-10,IL-12,IL-15 and IFN-α)Were detected by ELISA then compared and analyzed according to three factors:stage,pattern and intervention of hematodialysis.Results Compared with control group,serum levels of TNF-α,IL-1β,IL-4,IL-6,6,IL-8,IL-10 and IL-12 in HFRS cases significantly increased in febrile stage with the peak values in hypotensive-oliguric stages(P＜0.01).Serum kvels of IFN-α were lower than control group in all stages(P＜0.01).Serum levels of some phlogogenie mediators in severe group were higher than in mild group(P＜0.01).Serum levels of some phlogogenic mediators started to decrease after treatment with hematodialysis(P＜0.01).Comclusions 10 serum phlogogenic mediators all participate in the inflanmmtion process of HFRS.The pro-inflammatory and anti-inflammatory are unbalanced excretion.The over-excretion of TNF-α,IL-1β,IL-2,IL-4,IL-6,IL-8,IL-10,IL-12 and IL-15 results in the inflammation response.There is a positive correlation between the excretion and the inflammation damage.The lower level of IFN-α can't cause enough anti-virus effect.The hemmodialysis can significantiy decrease the serum phlogagenice mediator in patient's semm.relieve the inflammation damage.