参麦、丹参注射液治疗全身炎症反应综合征

目的 研究参麦、丹参注射液治疗全身炎症反应综合征(SIRS)的作用机理.方法 以脂多糖(LPS)腹腔注射Wistar大鼠制备SIRS动物模型,观察参麦、丹参注射液治疗后血常规、血清肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)水平变化,并进行肝、肺及肾脏组织的病理组织学检查.结果 参麦注射液及丹参注射液均能明显降低LPS腹腔注射后的血清TNF-α和IL-6水平,减轻肝、肺、肾等器官的损害,使SIRS大鼠48 h存活率明显提高.结论 参麦、丹参注射液可通过抑制大鼠炎症反应发挥抗SIRS作用.     

细胞因子在慢性肝衰竭合并全身炎症反应综合征病例中的意义

目的探讨TNF-α、IFN-γ、LPS、IL-10、IL-12、IL-18在慢性肝衰竭合并全身炎症反应综合征(SIRS)中的意义。方法运用双抗体夹心酶联免疫吸附法检测正常人、一般肝炎患者、慢性肝衰竭组的TNF-α、IFN-γ、LPS、IL-10、IL-12、IL-18。结果自正常对照组到一般肝炎组、慢性肝衰竭非SIRS组、慢性肝衰竭SIRS组,血清中TNF-α、LPS、IL-12及IL-18水平依次升高,IL-10分子水平依次减低,且各组间比较均具有显著性差异。结论TNF-α、LPS、IL-10、IL-12、IL-18水平可以反应出乙型肝炎患者的肝脏损伤程度和疾病严重程度,可能在慢性肝衰竭合并SIRS的发病过程中起到相当重要的作用。     

连续性血液净化在全身炎症反应综合征中的临床应用

目的探讨连续性静脉-静脉血液滤过(CVVH)在阻断全身炎症反应综合征(SIRS)向多器官功能障碍综合征(MODS)发展中的作用及机制。方法58例SIRS患者随机分为试验组(31例)和对照组(27例),并选20名正常体检者为正常组。对照组予常规综合治疗,试验组在常规综合治疗的同时加CVVH治疗。2组同时检测血清白介素-6(IL-6)、白介素-Iβ(IL-Iβ)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平,并观察SIRS临床指标的变化;正常组血检结果为正常对照。结果试验组T、RR、HR及WBC改善情况均明显优于对照组(P<0.05或P<0.01);血清CRP、IL-Iβ、IL-6和TNF-α水平均较对照组下降更为明显(P<0.01);转为MODS明显减少(P<0.05),病死率明显降低(P<0.05)。结论CVVH可通过下调炎症递质,调控机体炎症反应,阻断SIRS向MODS发展。     

超滤量的血液滤过对全身炎症反应的影响

目的研究高流量血液滤过(HVHF)对全身炎症反应综合征(SIRS)患者炎症介质水平和预后的影响。方法对ICU内31例SIRS患者接收血液滤过治疗,随机分为超滤量60ml·kg-1·h-1的HVHF组(15例)和超滤量35ml·kg-1·h-1的连续性静脉静脉血液滤过(CVVH)组(16例),每次血液滤过治疗时间不少于24h。分别于血液滤过前(T0)、滤过12h(T1)及24h(T2)抽取静脉血检测肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-8,并观察SIRS指标和APACHEⅡ评分。结果 T1时,HVHF组TNF-α、IL-6水平显著下降且低于CVVH组(P<0.05);T2时两组TNF-α、IL-6下降均不明显。两组的IL-8在治疗24h中均缓慢下降。两组治疗后SIRS指标和APACHEⅡ评分均显示明显改善,HVHF组的存活率明显高于CVVH组(P<0.05)。结论 HVHF降低SIRS患者炎症介质的效果较CVVH更为明显。     

自拟宣肺升降方对COPD急性发作期伴炎性反应综合征患者炎性反应的影响

目的分析自拟宣肺升降方对慢性阻塞性肺疾病急性发作期(AECOPD)伴炎性反应综合征(SIRS)患者的影响。方法将240例AECOPD伴SIRS患者随机分为研究组与对照组各120例。对照组患者入院后均按照2010年慢性阻塞性肺疾病诊治指南给予积极的抗生素控制感染、解除支气管痉挛、化痰等综合处理。研究组在对照组治疗基础上加用自拟宣肺升降方治疗。治疗前及治疗后第5天晨空腹静脉血测血清C反应蛋白(CRP)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平的变化,并同日评估患者当日急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)及肺功能,比较2组差异。结果治疗前2组FEV1/FVC及FEV1(%)和CRP、IL-β、TNF-α、APACHEⅡ评分差异无统计学意义(P>0.05)。治疗后2组FEV1/FVC及FEV1(%)高于治疗前,血清CRP、IL-β和TNF-α水平低于治疗前,APACHEⅡ评分低于治疗前,且研究组优于对照组,差异均有统计学意义(P>0.05)。结论自拟宣肺升降方对AECOPD伴SIRS患者具有改善肺功能水平作用,分析其机制与自拟宣肺升降方抑制血清中CRP、IL-1β及TNF-α水平有关。     

小儿全身炎症反应综合征血LPS、TNF-α、IL-10水平和IL-10/TNF-α比值的变化及其临床意义

目的比较全身炎症反应综合征（SIRS）患儿与健康儿童血内毒素（LPS）、肿瘤坏死因子-α（TNF-α）、白介素-10（IL-10）水平以及动态观察IL-10在SIRS发展过程中的变化。方法将SIRS患儿58例设为SIRS组,另21例健康儿童为对照组,分别采用鲎试剂动态比浊定量测定法、酶联免疫实验进行血LPS、TNF-α、IL-10的定量测定,计算IL-10/TNF-α比值,并对部分患儿进行IL-10和IL-10/TNF-α动态观察。结果SIRS组LPS、TNF-α、IL-10的水平均明显高于对照组（P〈0.01）,且TNF-α与IL-10的浓度随LPS水平升高而升高,2者呈显著正相关（P〈0.05）。血LPS、IL-10以及IL-10/TNF-α在病情恶化或死亡的病例中高于治愈或好转病例（P〈0.05）。结论LPS、TNF-α、IL-10的水平与IL-10/TNF-α比值的高低与SIRS预后有关。     

血液净化对脓毒血症患者炎症因子清除效果及预后影响

目的 观察连续性血液净化(CBP)对脓毒血症患者炎症因子清除及预后的影响.方法 2012年1月至2016年1月,随机将在我院治疗的62例脓毒血症患者分为两组,对照组31例,给予常规治疗,实验组31例,在常规治疗基础上给予CBP治疗,对比两组的炎症因子消除效果及预后的差异.结果 实验组的血CRP、IL-8、TNF-α水平,APACHEⅡ、SOFA评分,28d病死率较对照组明显降低,差异有统计学意义(P＜0.05).结论 CBP可改善脓毒血症患者过度炎症反应,对于恢复患者器官功能,保证患者良好预后有积极意义.     

血必净对恙虫病并发多器官功能障碍患者的保护作用

目的探讨血必净对恙虫病并发多器官功能障碍患者的保护作用。方法选取2009年2月~2013年8月本院收治的56例恙虫病并发多器官功能障碍患者作为研究对象,随机分为对照组与观察组。对照组给予常规疗法,实施对症治疗与器官支持治疗;观察组在对照组的基础上给予血必净注射液治疗。比较两组治疗前后的血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、内毒素(LPS)、肿瘤坏死因子(TNF)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、氧合指数(Pa O2/Fi O2)、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、血小板(PLT)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分水平变化。结果观察组的治愈率显著高于对照组,差异有统计学意义(P<0.05)。观察组治疗后的Pa O2/Fi O2、AST、ALT、APTT、PLT、APACHEⅡ水平显著优于治疗前及对照组治疗后,差异有统计学意义(P<0.05)。观察组治疗后的LPS、TNF、IL-6、IL-8水平显著低于治疗前,差异有统计学意义(P<0.05)。观察组治疗后的LPS、TNF水平显著低于对照组治疗后,差异有统计学意义(P<0.05)。结论血必净能够提高恙虫病并发多器官功能障碍患者的治愈率,并通过减少炎症介质分泌来实现对多器官功能障碍的保护作用。     

血液滤过联合血液灌流治疗重症急性胰腺炎疗效观察

目的观察传统方法联合连续性血液净化(CBP)治疗重症急性胰腺炎(SAP)的疗效。方法 16例SAP患者在接受传统治疗的同时给予连续性静脉-静脉血液滤过(CVVH)联合血液灌流治疗。监测CBP前后患者症状、体征及血清生化指标变化,进行急性生理学及慢性健康状况评分(APACHEⅡ)、多器官功能障碍综合征(MODS)评分,监测肿瘤坏死因子α(TNFα-)、C反应蛋白(CRP)水平。结果 CBP治疗后患者发热、心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解;血清胆红素、丙氨酸氨基转移酶、淀粉酶、尿素氮、肌酐、脂肪酶水平降低,酸中毒、低氧血症纠正,APACHEⅡ、MODS评分改善,血TNF-α、CRP水平下降(P<0.05)。16例患者中12例痊愈,存活率为75%。结论传统方法治疗SAP的同时行CBP,能有效救治临床并发症,保护器官功能,降低病死率,其机制可能与清除体内炎症介质有关。     

血必净注射液对重度急性有机磷农药中毒患者炎症介质的影响

目的:探讨血必净注射液对重度急性有机磷农药中毒(AOPP)患者全身炎性反应综合征(SIRS)的保护作用及其机制.方法:将45例重度AOPP患者随机分成血必净治疗组(23例)和常规治疗组(19例),血必净治疗组在正规治疗的基础上加用血必净注射液,对比观察2组治疗前及治疗后1、3、5 d的体温(T)、心率(HR)、呼吸频率(RR)、白细胞计数(WBC)、C反应蛋白(CRP)、血浆肿瘤坏死因子(TNF-α)、白细胞介素(IL)-6及IL-8.结果:治疗后3 d、5 d,与常规治疗组比较,血必净治疗组患者T、HR、RR、WBC以及CRP明显改善(P＜0.05),TNF-α、IL-6、IL-8明显降低(P＜0.05或P＜0.01).结论:血必净能有效抑制重度AOPP患者炎症反应过程,明显改善SIRS的症状,可能对AOPP患者的治疗起着重要的协同作用.     

n-3多不饱和脂肪酸对重症感染患者炎症反应的随机对照研究

目的探讨n-3多不饱和脂肪酸对重症感染患者的治疗作用及效果。方法通过随机对照研究,对80例重症感染患者肠外营养治疗时进行相关炎症指标监测,其中试验组的静脉营养液中添加n-3多不饱和脂肪酸。结果治疗7 d后,试验组与对照组之间的C-反应蛋白、转铁蛋白、免疫球蛋白(IgAI,gGI,gM)等免疫和炎症指标有显著性差异(P<0.05)。结论 n-3多不饱和脂肪酸对重症感染患者的炎症反应调控具有积极作用。     

早期肠内营养对休克后患者炎性反应的疗效研究

目的 研究早期肠内营养(EN)对休克患者内毒素及肿瘤坏死因子-α(TNF-α)的作用及全身炎性反应综合征(SIRS)的影响.方法 休克67例随机分为早期EN组和肠外营养(TPN)组,检测两组患者肠内营养治疗前、治疗后1、3、5 d血浆中内毒素与TNF-α水平;统计两组SIRS的持续时间与多器官功能障碍(MODS)的发生...     

ω-3多不饱和脂肪酸对急性肺损伤患者血浆TNF-α、IL-6、IL-10的影响

目的 观察、ω-3多不饱和脂肪酸对急性肺损伤患者的血浆TNF-α、IL-6、IL-10的影响.方法 选择急性肺损伤患者43例,随机分为两组.对照组(21例)予以常规治疗,治疗组(22例)常规治疗基础上加用ω-3多不饱和脂肪酸脂肪乳剂肠外应用.对比两组治疗前后第二、四、六、八天的TNF-α、IL-6、IL-10的变化.结...     

连续性血液净化治疗全身炎性反应综合征的效果及对机体免疫功能的影响

目的 探讨连续性血液净化(CBP)治疗全身炎性反应综合征(SIRS)的效果及对机体免疫功能的影响.方法 全身炎性反应综合征(SIRS)病人80例,根据其治疗方式分为对照组和观察组,其中对照组48例,观察组32例,对照组采用常规治疗,观察组在常规治疗的基础上给予连续性血液净化治疗(CBP).观察两组病人的治疗效果,比较两组病人治疗前后炎性细胞因子水平、免疫指标和肾功能指标的差异.结果 治疗手段是影响有效率的因素;观察组治疗的总有效率为96.88%,明显高于对照组(79.17%),差异有统计学意义(P<0.05);治疗前两组病人白细胞介素-10(IL-10)、白细胞介素-13(IL-13)和白介素-12(IL-12)等炎性细胞因子水平无明显差别,治疗后,两组病人的上述指标均降低,且观察组降低更明显(P<0.05);两组病人治疗前免疫球蛋白G(IgG)、免疫球蛋白A(IgA)和免疫球蛋白M(IgM)水平无明显差别,治疗后,两组病人的上述指标均较治疗前增高,且观察组增高明显;两组病人治疗前的谷丙转氨酶(ALT)、谷草转氨酶(AST)等肝肾功能指标无明显差异,治疗后,两组病人的上述指标水平均较治疗前降低,且观察组下降更明显(P<0.05).结论 连续性血液净化对SIRS病人有较好的治疗效果,可明显减轻机体炎性反应,提高病人的免疫功能,具有推广应用的价值.     

Antioxidant therapy reduces oxidative and inflammatory tissue damage in patients subjected to cardiac surgery with extracorporeal circulation

Ischaemia reperfusion injury is a pathophysiological event that occurs after cardiac surgery with extracorporeal circulation. This clinical event has been associated with the induction of oxidative and inflammatory damage in atrial tissue. Here, we tested whether combined omega 3 polyunsaturated fatty acids (n-3 PUFA)-antioxidant vitamin protocol therapy reduces oxidative and inflammatory cardiac tissue damage. This trial assigned 95 either-sex patients to supplementation with n-3 PUFA (2 g/day), or matching placebo groups, 7 days before on-pump surgery. Antioxidant vitamins C (1 g/day) and E (400 IU/day) or placebo were added from 2 days before surgery until discharge. Blood and atrial tissue samples were obtained during the intervention. Reduced/oxidized glutathione (GSH/GSSG) ratio, malondialdehyde (MDA) and protein carbonylation were determined in atrial tissue. Leucocyte count and high-sensitivity C-reactive protein (hs-CRP) in blood plus nuclear factor (NF)-κappaB activation in atrial tissue served for inflammation assessment. Lipid peroxidation and protein carbonylation were 27.5 and 24% lower in supplemented patients (p < 0.01). GSH/GSSG ratio was 38.1% higher in supplemented patients compared with placebo (p < 0.01). Leucocyte count and serum hs-CRP levels were markedly lower throughout the protocol in supplemented patients (p < 0.01). Atrial tissue NF-κB DNA activation in supplemented patients was 22.5% lower than that in placebo patients (p < 0.05). The combined n-3 PUFA-antioxidant vitamin protocol therapy here proposed reduced the oxidative stress and inflammation biomarkers, in patients undergoing on-pump cardiac surgery.     

Chronic risperidone normalizes elevated pro-inflammatory cytokine and C-reactive protein production in omega-3 fatty acid deficient rats

Prior clinical and preclinical studies suggest that omega-3 fatty acids negatively regulate pro-inflammatory signaling cascades, and that the atypical antipsychotic risperidone up-regulates omega-3 fatty acid biosynthesis. In the present study, we investigated the effects of chronic (40days) risperidone treatment (3mg/kg/day) on basal pro-inflammatory cytokine (interleukin-6, IL-6; tumor necrosis factor-alpha, TNFα) and C-reactive protein (CRP) production in control and n-3 fatty acid deficient rats. Relationships with erythrocyte polyunsaturated fatty acid composition were determined. Compared with untreated controls, untreated n-3-deficient rats exhibited significantly greater basal IL-6, TNFα, and CRP production. Following chronic risperidone treatment there were trends for greater IL-6, TNFα, and CRP production in controls, but these did not reach significance. In n-3-deficient rats, chronic risperidone normalized elevated IL-6, TNFα, and CRP levels. Erythrocyte arachidonic acid (20:4n-6) composition was positively correlated, and erythrocyte eicosapentenoic (20:5n-3) and docosahexaenoic acid (22:6n-3) inversely correlated, with plasma IL-6, TNFα, and CRP levels in untreated control and n-3-deficient rats, and these associations were not observed among risperidone-treated rats. The adrenic acid (22:4n-6)/arachidonic acid ratio, an index of elongase-mediated arachidonic acid biosynthesis, was reduced by risperidone in controls and elevated in n-3-deficient rats. These preclinical data demonstrate that chronic risperidone treatment normalizes constitutively elevated pro-inflammatory cytokine and CRP production in n-3 fatty acid deficient rats but not in controls, and that the mechanism is dissociable from n-3 fatty acid biosynthesis.     

Fatty acids and inflammation: the cutting edge between food and pharma

Inflammation underlies many common conditions and diseases. Fatty acids can influence inflammation through a variety of mechanisms, including acting via cell surface and intracellular receptors/sensors that control inflammatory cell signalling and gene expression patterns. Some effects of fatty acids on inflammatory cells appear to be mediated by, or at least are associated with, changes in fatty acid composition of cell membranes. Changes in these compositions can modify membrane fluidity, lipid raft formation, cell signalling leading to altered gene expression, and the pattern of lipid and peptide mediator production. Cells involved in the inflammatory response are typically rich in the n-6 fatty acid arachidonic acid, but the contents of arachidonic acid and of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can be altered through oral administration of EPA and DHA. Eicosanoids produced from arachidonic acid have roles in inflammation. EPA also gives rise to eicosanoids and these may have differing properties from those of arachidonic acid-derived eicosanoids. EPA and DHA give rise to resolvins which are anti-inflammatory and inflammation resolving. Thus, fatty acid exposure and the fatty acid composition of human inflammatory cells influences their function. As a result of their anti-inflammatory actions marine n-3 fatty acids have therapeutic efficacy in rheumatoid arthritis, although benefits in other inflammatory diseases and conditions have not been unequivocally demonstrated. The anti-inflammatory effects of marine n-3 fatty acids may contribute to their protective actions towards atherosclerosis, plaque rupture and cardiovascular mortality. The therapeutic dose of n-3 fatty acids is not clear.     

血必净对脑梗死合并全身炎症反应综合征的治疗作用及影响

目的探讨血必净对脑梗死合并全身炎症反应综合征的治疗作用及对炎性因子、C反应蛋白和肝肾功能的影响。方法我院2009年5月-2012年5月收治的脑梗死合并全身炎症反应综合征患者63例,随机分为治疗组和对照组,对照组予常规治疗,治疗组在常规治疗的基础上予血必净注射液100 mL,2次/d,疗程10d。比较治疗前后两组的临床疗效,检测肿瘤坏死因子(TNF)-2α、白细胞介素(IL)-6、IL-8水平变化。结果治疗组总有效率为93.75%,对照组总有效率为64.52%,两组比较,差异有统计学意义(P<0.05)。TNF-2α、IL-6、IL-8、CRP水平明显下降(P<0.05),AST、ALT、Cr水平明显降低(P<0.05)。结论血必净可改善脑梗死合并全身炎性反应且治疗后肝肾功能均有明显改善。     

Prostaglandin E2 and interleukin-8 production in human epidermal keratinocytes exposed to marine lipid-based liposomes

In response to exogenous stimuli such as non-sensitizing contact irritants, human keratinocytes produce various types of soluble pro-inflammatory mediators including prostaglandin E2 (PGE2) and interleukin 8 (IL-8). Polyunsaturated fatty acids of the n-3 series (n-3 PUFA) are known to play a role in the prevention of the inflammatory response. In this work, n-3 PUFA were supplied to keratinocytes through Marinosomes that are liposomes based on a natural marine lipid extract. Marinosomes contributed to reduce inflammation induced by croton oil by regulating PGE2 and IL-8 production in human keratinocyte cultures. However, the preventing effect of Marinosomes was highly dependent on the lipid concentration used and the liposome mean diameter.     

连续性静脉-静脉血液滤过在重症多发性创伤治疗中的应用

目的探讨连续性静脉-静脉血液滤过（CVVH）在阻断重症多发性创伤（SMI）所致的全身炎性反应综合征（SIRS）向多器官功能障碍综合征（MODS）发展中的作用及机制。方法58例重症多发性创伤伤员随机分为试验组（n=31）和对照组（n=27）,并选20名健康体检者为健康组。对照组予常规综合治疗,试验组在常规综合治疗的同时加CVVH治疗。两组同时检测血清白介素-6（IL-6）、白介素-Iβ（IL—Iβ）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）水平,并观察SIRS临床指标的变化;健康组检测结果为正常对照。结果试验组T、RR、HR及WBC改善情况均明显优于对照组（P〈0．05或P〈0．01）;血清CRP、IL—Iβ、IL-6和TNF-α水平均较对照组下降更为明显（P〈0．01）;转为MODS明显减少（P〈0．05）,死亡率明显降低（P〈0．05）。结论CVVH可通过下调炎症介质,调控机体炎性反应,阻断重症多发性创伤所致的SIRS向MODS发展。