白细胞与白细胞介素增高在急性高原病并发多器官功能障碍中的作用及临床意义

目的探讨白细胞（WBC）和白细胞介素（ILs）在重症急性高原病并发多器官功能障碍综合征（MODS）中的作用。方法采用调查表方式回顾性调查西藏军区总医院50年间住院治疗的3184例重症急性高原病患者的临床资料，对其WBC和ILs增高与多脏器功能障碍之间的关系进行相关分析。结果WBC计数及其分类在初发性与再发性高原肺水肿之间差异无统计学意义，在单纯性高原肺水肿与高原脑水肿之间差异也无统计学意义，但高原脑水肿伴高原肺水肿患者较其他3组WBC计数和中性粒细胞显著升高，淋巴细胞显著降低，差异有统计学意义（P均〈0．05）。急性高原病伴MODS患者WBC计数及中性粒细胞显著高于不伴MODS患者，淋巴细胞显著降低，差异均有统计学意义（P均〈0．01）。重症急性高原病患者的肿瘤坏死因子-α（TNF-α）、IL-1、IL-2、IL-6、IL-8含量均明显高于高原健康人群，而IL-4含量显著低于高原健康人群，差异均有统计学意义（P均〈0．01）。结论急性高原病患者存在全身炎症反应综合征（SIRS），SIRS在高原病致多器官功能损害中发挥了重要作用，是引起高原MODS的重要原因。

The clinical significance of leucocytosis and increase in interleukin content in acute mountain sickness complicated with multiple organ dysfunction syndrome

OBJECTIVE: To study the role of white blood cell (WBC) and interleukins (ILs) in acute mountain sickness (AMS) complicated with multiple organ dysfunction syndrome (MODS). METHODS: Three thousand one hundred and eighty-four patients suffering from severe AMC in the past 50 years were surveyed with questionnaire. Correlation analysis was done to explore the relationship between differential count of WBC and elevation of ILs contents and MODS. RESULTS: There was no difference in differential count of WBC between essential high altitude pulmonary edema (HAPE) and secondary HAPE. No difference was also found between simple HAPE and high altitude cerebral edema (HACE). However, obvious difference in WBC was found between HACE accompanied by HAPE and simple HAPE or simple HACE in the differential counts of WBC, counts of WBC and neutrophil were significantly elevated, while lymphocyte was significantly declined (all P < 0.05). The count of WBC in people suffering from AMS accompanied by MODS was higher than patients only suffering from AMS, lymphocyte was significantly decreased, the difference was obviously (both P < 0.01). The content of tumor necrosis factor-alpha (TNF-alpha), IL-1, IL-2, IL-6 and IL-8 of severe AMS patients were obviously higher than that of normal people, therefore the content of IL-4 in severe AMS patients was obviously lower than that normal people the difference were obvious (all P < 0.01). CONCLUSION: People suffering from AMS also exist systemic inflammatory response syndrome (SIRS). SIRS play an important part in MODS which is a major cause of AMS, and it's a critical factor of high altitude MODS.