脓毒症患者肿瘤坏死因子样凋亡微弱诱导剂的表达及意义

目的探讨脓毒症患者肿瘤坏死因子样凋亡微弱诱导剂（tumor necrosis factor-like weak inducer of apoptosis,TWEAK）的表达及其临床意义。方法全身炎症反应综合征（systemic inflammatory response syndrome,SIRS）患者112例,其中脓毒症患者75例为感染性SIRS组,非感染性SIRS患者37例为非感染性SIRS组。感染性SIRS组又分为脓毒症组22例、严重脓毒症组32例和脓毒性休克组21例,检测各组血清TWEAK、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-6（interleukin-6,IL-6）及C反应蛋白（C-reactive protein,CRP）水平。结果感染性SIRS组血清TWEAK与TNF-α水平明显高于非感染性SIRS组（P〈0.05）,IL-6、CRP水平与非感染性SIRS组比较差异无统计学意义（P〉0.05）;4组血清TWEAK、TNF-α水平两两比较差异有统计学意义（P〈0.05）,且随脓毒症程度加重,血清TWEAK、TNF-α水平逐渐升高;4组血清CRP、IL-6水平两两比较差异均无统计学意义（P〉0.05）;血清TWEAK水平在细菌、真菌及混合细菌真菌感染中差异无统计学意义（P〉0.05）。结论血清TWEAK水平与感染病原菌无关,脓毒症患者TWEAK含量明显升高,可作为脓毒症患者的重要检测指标。

Expression and significance of serum tumor necrosis factor-like weak inducer of apoptosis in septic patients

Objective To detect the expression of tumor necrosis factor-like weak inducer of apoptosis（TWEAK）in patients with sepsis and its clinical significance.Methods A total of 112 patients with systemic inflammatory response syndrome（SIRS）included 75 patients with infectious SIRS（infectious group）and 37 patients with non-infectious SIRS（non-infectious group）.Infectious group was redivided into sepsis group（n=22）,severe sepsis group（n=32）and septic shock group（n=21）.The serum TWEAK,tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）and C-reactive protein（CRP）were detected in all groups.Results The serum levels of TWEAK and TNF-αwere significantly higher in infectious group than those in non-infectious group（P〈0.05）,and there were no significant differences in IL-6and CRP levels between two groups（P〉0.05）.Significant differences in TWEAK and TNF-αlevels were found in multiple comparison among four groups（P〈0.05）,and the levels of TWEAK and TNF-αelevated with the aggravation of sepsis.There were no significant differences in CRP and IL-6levels among four groups in multiple comparison（P〉0.05）.TWEAK level showed no significant difference in bacteria,fungi and mixed infection of bacteria and fungi（P〉0.05）.Conclusion The level of TWEAK is not correlated with pathogenic bacteria infection,and the increased TWEAK level in septic patients can be used as an important indicator for sepsis.