危重症患者血清肿瘤坏死因子-α、白细胞介素-6及白细胞介素-10变化的研究

目的探讨危重症患者的血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）的变化，为判断危重症患者病情的严重程度提供新的客观指标。方法41例危重症患者中好转或治愈30例为存活组，死亡11例为死亡组，健康体检者20例为对照组。患者入住ICU后第1、7天清晨空腹抽取静脉血3ml，对照组抽空腹静脉血3ml，应用双抗体夹心酶联免疫吸附法检测血清中TNF-α、IL-6和IL-10的浓度。同时按急性生理和慢性健康评分系统（APACHEⅢ评分）方法进行危重症评分。结果危重症患者早期血清中促炎因子TNF-α、IL-6及抗炎因子IL-10的浓度均较对照组明显升高，存活组和死亡组与对照组比较均有统计学意义；TNF-α、IL-6、IL-10及APACHEⅢ评分四项指标两两之间呈显著性相关（P〈0．05）。结论促炎因子TNF-α、IL-6和抗炎因子IL-10在危重症患者中起重要作用，决定患者的预后。TNF-α、IL-6和IL-10浓度同APACHEⅢ评分一样可作为危重症预警的价值参数。

The serum changes of TNF-α,IL-6 and IL-10 in the intensive care patient

Objective To analyze the correlation between APACHE Ⅲ Score and serum changes of TNF-α, IL-6 and IL-10 in patients in intensive care unit. Methods Fourty-one patients (study group) transferred to ICU were divided into survival group and death group. Blood samples were collected from the study subjects and 20 control subjects respectly on the 1 st and 7th day after admission and were examined for the levels of TNF-α, IL-6 and IL-10 with enzyme-linked immunosorbent assay (ELISA). Meanwhile, APACHE Ⅲ Score for each patient was recorded everyday. Results The serum levels of TNF-α, IL-6 and IL-10 in study group were significantly higher than that in control group in the first admission day(P ＜ 0.05 ). TNF-α and IL-6 were decreased on the 7th day while IL-10 was still high. According to APACHE Ⅲ Score, the scores in death group were all significantly higher than that in survival Group on both days. The serum levels of TNF-α,IL-6 and IL-10 were relative to APACHE Ⅲ score ( P＜ 0.05 ). Conclusion Pro-inflammatory cytokines ( TNF-α, IL-6 ) and anti-inflammatory cytokines ( IL-10) are important parameters for the prognosis of the intensive care patient. Combined with APACHE Ⅲ score,TNF-α,IL-6 and IL-10 levels can be used as assistant indexes for evaluation of the severity of critical patient.