脓毒血症患者抗炎和促炎指标动态变化在临床病情评估中的意义

目的：研究脓毒血症患者抗炎、促炎指标动态变化在临床病情评估中的意义。方法2010～2011年该院 EIC U收治的脓毒血症患者43例作为研究对象，根据预后分为存活组和死亡组。采集诊断明确后第1、3、5、7天清晨血清样本，双抗体夹心ELISA法测定促炎指标[肿瘤坏死因子‐α（TNF‐α）、白细胞介素（IL‐1）]、抗炎指标（IL‐4、IL‐10）血清浓度，同时动态监测急性生理和慢性健康状况评分（APACHE Ⅱ）。结果两组 TNF‐α、IL‐1均呈早期上升，病程进展第3天达到峰值水平，之后逐渐下降，在相同监测时间点死亡组各项指标均显著高于存活组（ P＜0．05）。两组IL‐4在第5天达到峰值水平后下降，在相同监测时间点死亡组指标均显著高于存活组（P＜0．05）。存活组IL‐10在第5天达到峰值水平后下降；死亡组IL‐10水平呈现逐渐升高，并维持高位，第3、5、7天IL‐10血清浓度差异无统计学意义（P＞0．05）。存活组APACHE Ⅱ呈显著下降趋势，而死亡组则呈上升趋势并维持高评分值。结论 TNF‐α、IL‐1在脓毒血症早期呈迅速升高并达峰值，IL‐4、IL‐10升高并达峰值时间较促炎指标延后，其中IL‐10持续维持高水平提示预后不良。

Dynamic changes of the serum pro-and anti-inflammatory cytokines and its significance in assessing clinical condition for sepsis patients

Objective To investigate the dynamic change of pro‐and anti‐inflammatory eytokines of sepsis patients and its signif‐icance in clinical condition .Methods Forty‐three sepsis patients from 2010 to 2011 were divided into the survival group and the death group .Morning serum samples were collected on the first ,third ,firth and seventh day morning ;ELISA method was used to quantify the serum level of TNF‐α,IL‐1 ,IL‐4 and IL‐10 .The severity of patient′s condition was assessed according to the APACHEⅡsystem .Results In the early stage ,TNF‐α and IL‐1 in of both group increased and reached the peak on the third day ;then there was a gradual decline .Test in the same time point showed that the indexes of death group were all higher than that of survival group (P<0 .05) .IL‐4 of the two groups reached its peak on the fifth day and then declined ,and in the same time point ,indexes of death group were much more higher than that of survival group (P<0 .05) .IL‐10 of the survival group reached its peak on the fifth day and then declined;in the death group ,IL‐10 level kept increasing and maintained high ,there was no significant difference among the serum levels of the third ,fifth and seventh day(P>0 .05) .The APACHE Ⅱ of the survival group declined significantly while in death group it kept increasing and stay high .Conclusion Pro‐inflammatory eytokines(TNF‐α,IL‐1) ascended earlier than anti‐in‐flammatory eytokines(IL‐4 ,IL‐10) ,and the serum level of IL‐10 keep high level prompt the poor prognosis .