严重烧伤患者促炎和抗炎细胞因子的变化及其意义

目的检测严重烧伤患者血清中促炎和抗炎细胞因子水平,探讨严重烧伤患者体内免疫状态变化的特点。方法选取烧伤总体表面积（TBSA）〉30%的患者64例,按烧伤面积将严重烧伤患者分为2组：Ⅰ组39例（TBSA 30%~50%）,Ⅱ组25例（TBSA〉50%）;同时选取年龄和性别相匹配的20例健康人作为对照组。分别收集烧伤患者伤后1、3、7和21d的血清,采用酶联免疫吸附试验法（ELISA）检测血清中促炎细胞因子IL-6、IL-8、TNF-α和抗炎细胞因子IL-4、IL-10、G-CSF的浓度。结果 （1）与对照组相比,两组烧伤患者血清中促炎细胞因子IL-6、IL-8、TNF-α和抗炎细胞因子IL-4、IL-10、G-CSF在烧伤后不同时间点均显著增高（P〈0.01）。（2）烧伤Ⅱ组IL-6水平在伤后7d明显高于烧伤Ⅰ组（P〈0.05或P〈0.01）,并持续较长时间。烧伤Ⅱ组血清中IL-8和TNF-α水平在伤后1d就显著高于烧Ⅰ组（P〈0.01）。（3）烧伤II组IL-4、G-CSF水平在伤后3d明显高于烧伤Ⅰ组（P〈0.05或P〈0.01）,并持续较长时间。烧伤Ⅱ组血清中IL-10水平在伤后1d就显著高于烧伤Ⅰ组（P〈0.01）。结论严重烧伤患者体内促炎抗炎细胞因子处于失衡状态,并且不同烧伤面积的烧伤患者促炎和抗炎细胞因子的表达存在明显差异,早期监测严重烧伤患者的促炎和抗炎细胞因子水平对疾病的治疗具有重要意义。

Changes of serum of pro-and anti-inflammatory cytokines in severely burned patients

Objective To investigate the characteristics of immune status changes in severely burned patients by analyzing the serum concentrations of pro-and anti-inflammatory cytokines.Methods A total of 64patients with total burn surface area（TBSA） larger than 30% were included in the study and divided into two groups according to the burn area：Group Ⅰ（TBSA of 30%50%,n=39）and GroupⅡ（TBSA＆gt;50%,n=25）.20sex and age paired healthy controls were also enrolled in this study.The serum were collected at days postburn：1d,3d,7dand 21d.The levels of IL-6,IL-8,TNF-α,IL-4,IL-10and G-CSF were measured by ELISA.Results Compared with healthy control,the levels of pro-inflammatory cytokines IL-6,IL-8,TNF-αand anti-inflammatory cytokines IL-4,IL-10,G-CSF were significantly increased in severely burned patients during the observation period（P＆lt;0.01）.The levels of IL-8,TNF-αand IL-10in GroupⅡ were much higher than those in GroupⅠ during the observation period（P＆lt;0.01）.The levels of IL-6,IL-4and G-CSF in GroupⅡ were much higher than those in GroupⅠat days 7-21,3-21and 3-21postburn（P＆lt;0.05or P＆lt;0.01）.Conclusion There are large perturbations in the expression of pro-and anti-inflammatory cytokines in severely burned patients and the levels of these cytokines show significant differences in patients with different burn areas.Their monitoring allows for an assessment of the immunological status which is helpful to reduce post-burn immune dysfunction and enhance burn healing.