癫痫持续状态并发全身炎症反应综合征患者血清肿瘤坏死因子-α和白细胞介素-10水平变化

目的探讨癫痫持续状态(SE)并发全身炎症反应综合征(SIRS)患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)水平的变化,及其与多器官功能障碍综合征(MODS)和患者病死率的关系。方法 49例SE患者根据是否并发SIRS分为SE并发SIRS组19例和SE组30例,分别于发病24 h内及第3、7天采用放射免疫法测定血清TNF-α和IL-10水平,并观察2组患者MODS发生率及病死率。结果 2组患者发病24 h及第3、7天不同时间血清TNF-α水平比较差异均有统计学意义(SE组:F=252.755,P=0.000;SE并发SIRS组:F=738.096,P=0.000);2组患者血清TNF-α水平在发病第3天时达到高峰;发病24 h及第3、7天时,SE并发SIRS组血清TNF-α水平显著高于SE组,差异均有统计学意义(t24 h=7.261,P=0.000;t3 d=9.726,P=0.000;t7 d=11.422,P=0.000)。2组患者发病24 h及第3、7天不同时间血清IL-10水平比较差异均有统计学意义(SE组:F=5.755,P=0.005;SE并发SIRS组:F=7.561,P=0.001);2组患者血清IL-10水平在发病第3天时达到高峰;发病24 h及第3、7天时,SE并发SIRS组患者血清IL-10水平均显著高于SE组,差异均有统计学意义(t24 h=3.108,P=0.003;t3 d=2.552,P=0.014;t7 d=2.767,P=0.008)。SE并发SIRS组和SE组患者MODS发生率分别为42.11%、16.67%,SE并发SIRS组患者MODS发生率显著高于SE组,差异有统计学意义(χ2=13.890,P=0.049)。SE并发SIRS组和SE组患者病死率分别为26.32%、3.33%,SE并发SIRS组患者病死率显著高于SE组,差异有统计学意义(Fisher确切概率法,P=0.027)。结论TNF-α和IL-10可能参与了SE患者并发SIRS的发生、发展过程,TNF-α和IL-10可作为预测MODS的早期指标。

Levels of tumor necrosis factor-or and interleukin-10 in patients with status epilepticus complicating systemic inflammatory response syndrome

Objective To explore the levels of tumor necrosis factor-α（TNF-α） and interleukin-10 （IL-10） and the relationship to multiple organ dysfunction syndrome（MODS） and case fatality rate in patients with status epileptieus（SE） complicating systemic inflammatory response syndrome（SIRS）. Methods A total of 49 patients with SE were divided into SE ＋ SIRS group （19 cases） and SE group（ 30 cases） according to whether they complicated with SIRS. The levels of serum TNF-α and IL-10 were detected by radioimmunity method at the time point of 24 hours, the 3ra and 7th day after onset. The MODS rate and case fatality rate were observed in the two groups. Results There were significant differences in the levels of serum TNF-α at the different time of 24 hours, the 3^rd and 7^th day after onset in the two groups （ SE group ： F = 252. 755, P = 0. 000 ; SE ＋ SIRS group：F = 738. 096, P = 0. 000）. The level of serum TNF-α reached a peak on the third day in the two groups. The level of serum TNF-α in SE ＋ SIRS group was significantly higher than that in SE group at the time point of 24 hours ,the 3^rd and 7^th day after onset（ t24 h = 7. 261, P = 0. 000 ; t3d = 9. 726, P = 0. 000 ; t7 d = 11. 422, P = 0. 000 ）. There was no significant difference in the level of serum IL-10 at the different time of 24 hours, the 3^rd and 7^th day after onset in the two groups （SE group： F = 5. 755 ,P =0. 005 ;SE ＋ SIRS group ：F=7. 561 ,P =0. 001 ）. The level of serum IL-10 reached a peak on the 3rd day in the two groups. The level of serum IL-10 in SE ＋ SIRS group was significantly higher than that in SE group at the time point of 24 hours,the 3ra and 7th day after onset（t24h =3. 108,P =0. 003;t3 a =2. 552,P =0. 014;t7 a =2. 767,P =0. 008）. The MODS rate in SE ＋ SIRS group and SE group was 42.11% and 16.67%, respectively;the MODS rate in SE ＋ SIRS group was significantly higher than that in SE group （X^2 = 13. 890, P = 0. 049 ）. The case fatality rate in SE ＋ SIRS group and