血液灌流对氟乙酰胺的清除作用及TNF-α、IL-10水平的影响

目的探讨氟乙酰胺中毒对TNF-α、IL-10水平的影响及血液灌流对其清除作用。方法建立犬急性氟乙酰胺中毒模型，分为HP组和对照组，应用炭肾对HP组进行血液灌流（HP）2h，对照组只连接体外循环，对比分析两组在HP前、HP后不同时间点血浆中氟乙酰胺浓度及TNF-α、IL-10水平的动态变化。结果对照组和HP组在氟乙酰胺中毒后TNF-α、IL-10水平明显增高；HP组HP后血中氟乙酰胺浓度由（159．06±18．31）μg／ml，降至HP2h的（41．94±4．83）μg／ml，显著低于对照组（P〈0．01），HP后氟乙酰胺浓度逐渐降低；随着氟乙酰胺浓度的降低，IL-10水平也有下降趋势，但差异无统计学意义（P〉0．05）；TNF-α则在HP2h内逐渐下降，而HP后又轻微回升并维持在一定的水平，差异均无显著意义（P〉0．05）。结论氟乙酰胺中毒后可引起TNF-α、IL-10水平升高；HP可显著降低血中氟乙酰胺浓度；HP前后血清中TNF-α、IL-10的水平变化不明显。

The cleaning effect of hemoperfusion in fluoroacetamide poisoning and TNF-α, IL-10 Levels

Objective To investigate the clinical features and treatment methods of pheochromotocyto-ma in multiple endocrine neoplasia type 2A patients. Methods Three unrelated families, among of which 8 were clinically diagnosed MEN2A patients, pheochromocytoma was found in all( 100% )of the 8 MEN2A patients. We analysis the clinical feature of blood pressure, the result of 24 hour urine vanillyl mandelic acid (VMA) and adre-nal CT, the treatment methods of pheochromocytoma. Results Medullary thyroid carcinoma(MTC) was found in 7(87.5% )patients,and pheochromocytoma was found in all(100%)of the 8 MEN2A patients. Hyperplasia or adenoma of the parathyroid gland was not found in any of these cases. Among them, pheochromocytoma was the initial demonstration of the syndrome in 6 patients(75%) ,and bilateral phoochromocytomas were found in 7 of them (87.5 %). 3 (37.5 %)patients present as sustained hypertension and 5 (62.5 %)patients present as parox-ysmal hypertension,75% of VMA was elevated and another 25% VMA/Cr was elevated. 4 (50%) patients were operated by open method and 4 (50%) patients were operated by video-assisted laparoscopic method. Conclu-sion The study indicated that pheochromocytomns was usually bilateral in MEN2A patients. The hypertension may be sustained or paroxysmal, the examinations of biology, imaging and RET gene mutation were useful for early diagnosis and treatment of pheochromotocytoma in MEN2A patients. Laparoscopic surgery was the best choice of treatment.