多器官功能障碍综合征患者血管内皮损伤与炎性相关因子的研究

目的探讨多器官功能障碍综合征（MODS）患者循环内皮细胞（CEC）数量，凝血、纤溶指标和炎性相关因子的变化及其相关性。方法35例MODS患者为MODS组，20名健康体检者作为正常对照组。用Percoll密度梯度离心法分离血CEC，检测血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FG）、D-二聚体以及血清肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）水平。动态观察CEC、TNF-α和IL-6的变化，并分析CEC、TNF-α和IL-6与PT、APTT、FG和D-二聚体之间的相关性。结果与正常对照组比较，MODS组CEC数量明显增加。血清TNF-α、IL-6水平亦明显升高，PT、APTT延长，FG下降，血浆D-二聚体升高，差异均有显著性（P均〈0．05）。CEC数量及血清TNF-α、IL-6水平随时间延长逐渐增加；CEC数量与TNF-α、IL-6水平呈显著正相关（r1=0．536，P1=0．000；r2=0．412，P2=0．002），与PT、APTT、FG、D-二聚体间未发现相关关系；TNF-α、IL-6与PT、APTT呈显著正相关，与FG、D-二聚体无明显相关性。结论MODS患者血中炎性相关因子水平增加，血管内皮细胞功能受损，炎性相关因子在血管内皮损伤中起关键作用，CEC数量增加与炎症引起的血管内皮损伤有关。

Study on vascular endothelial injuries and inflammation related cytokines in patients with multiple organ dysfunction syndrome

OBJECTIVE: To investigate the relationship between the circulating endothelial cell (CEC), coagulation, fibrinolysis indexes and inflammation related cytokines in patients with multiple organ dysfunction syndrome (MODS). METHODS: Thirty-five patients with MODS (MODS group) and 20 healthy individuals (control group) were enrolled for study. CECs were harvested by isopycnic centrifugation method. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FG), D-dimer, and serum tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) were determined simultaneously. The relationship between dynamic changes in CEC, TNF-alpha, IL-6 and that in PT, APTT, FG, D-dimer was analyzed. RESULTS: Compared to the control group, CEC numbers, serum TNF-alpha, IL-6 levels and plasma D-dimer level significantly increased, PT and APTT were prolonged, and FG significantly decreased in MODS group (all P<0.05). The quantity of CEC and serum levels of TNF-alpha and IL-6 elevated with the lapse of time. Correlation analysis revealed a significant positive correlation between CEC and serum levels of TNF-alpha and IL-6 (r(1)=0.536, P(1)=0.000; r(2)=0.412, P(2)=0.002), and the same correlation between serum TNF-alpha, IL-6 levels and PT, APTT. CONCLUSION: Elevation of serum inflammation related cytokines and vascular endothelial cell damage occur in MODS patients. Serum inflammation related cytokines play an important role in endothelial damage, and an increase in CEC number may be attributed to vessel injury.