清胰汤对重症急性胰腺炎细胞因子白细胞介素8及10的影响

[目的]探讨中药清胰汤对重症急性胰腺炎(SAP)患者的治疗作用及对细胞因子白细胞介素8、10(IL-8、IL-10)的影响.[方法]将符合SAP诊断标准的患者随机分为综合治疗组和联合清胰汤组,综合治疗组给予常规西药、胃肠减压等治疗,联合清胰汤组给予清胰汤加综合治疗,其他辅助治疗及护理等影响因素相同,分别检测发病24 h内,第2、4天的IL-8、IL-10水平及入院后第4、8天患者的APACHE-Ⅱ评分、血清淀粉酶(AMY)、血清清蛋白(Alb)及三酰甘油(TG)水平.并选取轻症急性胰腺炎(MAP)作为对照.[结果]发病24 h内SAP患者的1L-8、IL-10水平均明显高于MAP患者(P＜0.05);联合清胰汤组第2、4天IL-8、IL-10水平低于综合治疗组(P＜0.05).SAP 2组患者治疗前后AMY、Alb水平无显著变化,但联合清胰汤组血清TG水平及APACHE-Ⅱ评分明显低于综合治疗组(P＜0.05).[结论]SAP患者全身炎症反应综合征(SIRS)的程度明显重于MAP患者;清胰汤联合西药治疗能有效降低APACHE-Ⅱ评分,清胰汤治疗SAP的可能机制是通过减少急性期IL-8、IL-10等细胞因子的释放而抑制SIRS反应.     

Cytokines (IL-6, IL-8, TNF): early and reliable predictors of severe acute pancreatitis

BACKGROUND: Severe acute pancreatitis is associated with a high mortality, especially when compared with mild acute pancreatitis. Early intervention in patients with severe acute pancreatitis has been shown to improve mortality. The value of cytokines (interleukin [IL]-6, IL-8 and tumor necrosis factor [TNF]-alpha) in diagnosing severe acute pancreatitis at an early stage was studied. STUDY: Thirty-six patients with acute pancreatitis were prospectively evaluated. Age-matched controls were obtained from healthy volunteers. Levels of IL-6, IL-8, and TNF-alpha were obtained within 24 hours of admission. Ranson's prognostic signs and Bank's clinical criteria were used to differentiate patients into mild and severe pancreatitis. RESULTS: There was significant difference in IL-6 levels between controls and mild pancreatitis, controls and severe pancreatitis, and mild and severe pancreatitis. IL-8 levels were significantly different between controls and severe pancreatitis and mild and severe pancreatitis. There was no significant difference between controls and mild pancreatitis. The results for TNF-alpha were similar to the findings for IL-8. CONCLUSION: IL-6, IL-8, and TNF can be used independently in differentiating mild acute pancreatitis from early severe acute pancreatitis.     

血清IL-6、IL-8和TNF-α在重症急性胰腺炎早期诊断中的临床意义

目的对血清白介素-6(IL-6)、白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)等细胞因子在早期诊断重症急性胰腺炎(severe acute pancreatitis,SAP)中的价值进行研究.方法以Ranson和APACHE-Ⅱ评分为标准,把36例急性胰腺炎患者分成轻症胰腺炎组(MAP)及重症胰腺炎组(SAP)两组,选择年龄匹配的13名健康志愿者为对照组(Con);在患者入院24 h内采静脉血并检测血清中IL-6、IL-8和TNF-α水平.结果三种细胞因子血清水平均为SAP组最高,Con组最低,其中IL-6水平在三组之间、两两之间均有显著差异,IL-8和TNF-α水平在Con组与SAP组之间、MAP组与SAP组之间有显著差异,而Con组与MAP组之间无显著差异.结论IL-6、IL-8、TNF-α对早期诊断鉴别轻症胰腺炎和重症胰腺炎均有重要的临床意义.     

血清IL-6、IL-8和TNF—α在重症急性胰腺炎早期诊断中的临床意义

目的 对血清白介素-6(IL-6)、白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)等细胞因子在早期诊断重症急性胰腺炎(severe acute pancreatitis，SAP)中的价值进行研究。方法 以Ranson和APACHE—Ⅱ评分为标准，把36例急性胰腺炎患者分成轻症胰腺炎组(MAP)及重症胰腺炎组(SAP)两组，选择年龄匹配的13名健康志愿者为对照组(Con)；在患者入院24h内采静脉血并检测血清中IL-6、IL-8和TNF-α水平。结果 三种细胞因子血清水平均为SAP组最高，Con组最低，其中IL-6水平在三组之间、两两之间均有显著差异，IL-8和TNF—α水平在Con组与SAP组之间、MAP组与SAP组之间有显著差异，而Con组与MAP组之间无显著差异。结论 IL-6、IL-8、TNF—α对早期诊断鉴别轻症胰腺炎和重症胰腺炎均有重要的临床意义。     

还原型谷胱甘肽对重症急性胰腺炎患者IL-6、IL-8及TNF-α的影响

目的 研究还原型谷胱甘肽(GSH)对SAP患者血清IL-6、IL-8及TNF-α含量的影响.方法 32例SAP患者按随机数字法分成GSH组及常规治疗组,各16例,选择年龄匹配的16名健康志愿者作为对照组.患者入院24 h内以及治疗7 d后采血检测血清中IL-6、IL-8和TNF-α水平.结果 SAP患者治疗前IL-6、IL-8和TNF-α水平分别为(81.34±5.99)ng/L、(97.81±15.61)ng/L和(28.21±1.53)ng/L,显著高于对照组的(16.69±2.86)ng/L、(26.42±1.59)ng/L和(15.89±1.41)ng/L(P＜0.05).治疗7 d后,GSH组的IL-6、IL-8和TNF-α水平分别为(31.21±3.88)ng/L、(35.51±1.27)ng/L和(16.15±1.31)ng/L,常规治疗组为(53.88±6.21)ng/L、(51.91±9.88)ng/L和(17.88±1.51)ng/L,均较治疗前显著下降(P＜0.05),GSH组下降程度显著大于常规治疗组(P＜0.05).结论 GSH能降低SAP患者血清炎症细胞因子水平,对治疗SAP有一定疗效.     

急性胰腺炎外周血IL-6、IL-8、TNF-α的变化及与APACHEⅡ评分的相关性

目的探讨急性胰腺炎(acute pancreatitis, AP)患者外周血细胞因子的变化与APACHEⅡ评分的相关性.方法化学发光法检测66例AP患者外周血IL-6、IL-8、TNF-α的变化及按APACHEⅡ评分,评估病情的严重程度.结果 AP患者中IL-6、IL-8、TNF-α的含量明显增高,与正常对照组比较差异非常显著(P < 0.01),细胞因子的变化与病情严重程度相一致,与APACHEⅡ评分呈正相关.结论 IL-6、IL-8、TNF-α和APACHEⅡ评分能够作为评价AP严重程度的客观指标.     

Serum profiles of interleukin-6, interleukin-8, and interleukin-10 in patients with severe and mild acute pancreatitis

Excessive leukocyte activation has been proposed as a key mechanism in the onset of acute pancreatitis. In this study, we assessed the systemic release of various inflammatory mediators and tried to identify differences between patients with mild and severe disease. In a prospective study, 19 patients admitted for severe acute pancreatitis were compared with 24 patients with mild pancreatitis. Serum levels of interleukin-6 (IL-6), IL-8, and IL-10 were determined at the time of admission, and on days 1, 2, and 5 after hospitalization. Severity of pancreatitis was determined according to the Atlanta criteria. IL-6 levels peaked on admission in both groups with significant differences (p < 0.05) from days 0-2. IL-8 levels increased from day 0 in severe cases, and from day 1 in mild cases, to reach a plateau between days 2 and 5; significant differences were observed on days 0 and 1. IL-10 was highest on day 0; it decreased rapidly in mild cases but stayed significantly higher from days 1 to 5 in severe cases. These findings provide new evidence on the role of mediators of the inflammatory/antiinflammatory balance in acute pancreatitis. These molecules appear to be valuable early markers of severity.     

急性胰腺炎合并急性肺损伤与血清中IL-6变化的关联性研究

目的：探讨白细胞介素－6（IL－6）在急性胰腺炎合并急性肺损伤发生发展中的临床意义。方法入选患者96例,分为急性胰腺炎组62例及急性胰腺炎合并急性肺损伤组34例,以健康成人30名为对照组。采用放射免疫法测定血清中IL－6含量变化,进行统计学分析。结果急性胰腺炎组和急性胰腺炎合并急性肺损伤组IL－6值均高于对照组,急性胰腺炎合并急性肺损伤组高于急性胰腺炎组,差异均有统计学意义（ P＜0．05）。结论 IL－6作为炎症启动因子,参与急性胰腺炎合并肺损伤的病理生理过程。     

Prognostic factors in acute pancreatitis

Prognostic factor scoring systems provide one method of predicting severity of acute pancreatitis. This paper reports the prospective assessment of a system using nine factors available within 48 hours of admission. This assessment does not include patient data used to compile the system. Of 405 episodes of acute pancreatitis occurring in a seven year period, 72% had severity correctly predicted by the system; 31% of 131 episodes with three or more factors present were severe and 8% of 274 episodes with less than three factors were severe. Assessment of individual factors revealed only one which did not predict severity. A scoring system based on the other eight factors correctly predicted severity in 79% of episodes. Prognostic factor scoring systems (i) alert the clinician to potentially severe disease, (ii) allow comparison of severity within and between patient series and (iii) will allow rational selection of patients for trials of new treatment.     

急性胰腺炎血清sTNF-R、IFN-γ、IL-6、IL-8、NO、NOS水平与其严重程度的研究

目的　探讨急性胰腺炎 (AP)血清可溶性肿瘤坏死因子受体 (sTNF R)、γ 干扰素 (IFN γ)、白细胞介素 6(IL 6)、白细胞介素 8(IL 8)、一氧化氮 (NO)和一氧化氮合成酶 (NOS)的临床意义。方法　分为三组 ,轻症AP(MAP)组 ,重症AP(SAP)组和对照组。在发病 3天内取外周静脉血检测 ,同期测定对照组。结果　MAP组sTNF R、IFN γ、IL 6及IL 8水平明显高于对照组 (P <0 0 5 ) ,NO及NOS水平均略高于对照组 (P >0 0 5 ) ,SAP组所有因子均高于MAP组 (P <0 0 1,P <0 0 5 )。结论上述血清因子有助于判断AP严重程度和预后 ,具有积极的临床意义     

Prognostic indicators in acute pancreatitis.

Several approaches have been used in an attempt to predict the severity and prognosis of attacks of acute pancreatitis. The Ranson and Glasgow criteria include a variety of simple laboratory parameters that are measured on admission and again within 48 h. They are the most widely used indices in clinical practice. The Acute Physiological and Chronic Health Evaluation II system is more complicated, but can be applied to a wide variety of conditions, especially in intensive care settings. The usefulness of this system depends on the threshold score for defining severe pancreatitis; a score of eight appears to be the most appropriate. The finding of nonperfused areas in the pancreas at contrast-enhanced computed tomography is indicative of pancreatic necrosis and portends an unfavourable prognosis. Other clinical and laboratory indices have been proposed, but the most important predictive factor of early mortality seems to be the presence and persistence of a Marshall organ failure score of two or more. This is especially true if organ dysfunction persists beyond 36 h. Radiological findings do not always correlate well with the presence of organ dysfunction, and more investigations are required.     

Prognostic factors in acute pancreatitis.

The assessment of the severity of acute pancreatitis (AP) is a critical early step in its management, as severity of AP predicts prognosis. A range of options are available for assessment of severity in AP, including clinical evaluation, standardized prognostic criteria, computed tomography (CT), and biochemical markers. Clinical assessment has limited accuracy for predicting severity early in the course of AP. Therefore, additional assessment using biochemical and radiologic criteria in combination with standardized criteria is appropriate to determine severity and prognosis in AP; a strategy emphasizing daily assessment of severity should be used. The APACHE II is the scoring system of choice for evaluating severity in AP, although it remains an imperfect tool. Computed tomographic grading of AP and the development of the CT severity index allow for heightened accuracy in the prediction of severity. C-Reactive protein is the standard for serum marker assessment of severity and prognosis in AP; other markers, including interleukin-6, polymorphonuclear elastase, and trypsinogen activation peptide, hold promise. The focus of this review is to examine the role of diagnostic tests in evaluating severity and predicting prognosis among patients with AP and to provide a diagnostic algorithm for initial management.     

Serum IL-4, IL-10 and IL-6 levels in inflammatory arthritis

As the available in vitro and in vivo data suggest that interleukin (IL)-4 and IL-10 have immunosuppressive activity, our hypothesis was that serum IL-4 and IL-10 levels would correlate inversely with parameters of inflammation in patients with inflammatory arthritis. IL-4 was detected in the serum of 12 out of 140 patients with rheumatoid arthritis (RA), which was increased compared to the proportion found with patients with osteoarthritis (OA; P< 0.02). In addition, IL-4 was detected in the serum of 2 of 19 patients with systemic lupus erythematosus (SLE), 2 of 24 patients with psoriatic arthritis and 1 of 5 patients with Behçet's syndrome. No IL-4 was detected in patients with the following conditions: OA (58 patients), gout (17 patients), ankylosing spondylitis (6 patients), Reiter's syndrome (6 patients), polymyalgia rheumatica (6 patients), temporal arteritis (5 patients) and scleroderma (3 patients). No IL-10 was detected in any of the sera tested. We discuss the possible relevance of these results to the regulation of the immune response evident in inflammatory arthritis.     

PCT、hs-CRP及IL-6的水平变化对急性胰腺炎的临床意义

目的探讨急性胰腺炎(AP)患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)水平变化及临床意义。方法选取黄石市中心医院2011年9月-2014年1月收治的AP患者153例,同时选取150名健康体检者作为对照组;将153例AP患者分为72例SAP组和81例MAP组;在所有AP患者中随机选取48例SIRS患者和48例非SIRS患者,对以上各组患者进行相关血清指标的监测。结果 AP组患者在第1天、第4天和第7天的血清PCT、hs-CRP和IL-6水平均高于对照组(P0.05);SAP患者与MAP患者相比,在第1天、第4天和第7天PCT、hs-CRP和IL-6水平均较高(P0.05);SIRS患者和非SIRS患者相比,PCT水平差异有统计学意义(P0.05)。结论血清PCT、hs-CRP和IL-6水平对于AP病情的诊断具有重要临床意义。PCT水平的监测有助于判断AP患者的感染严重程度,值得进一步的探讨分析。