系统性炎症反应综合征患者血浆D-二聚体与细胞因子动态变化的研究

目的探讨系统性炎症反应综合征(SIRS)患者血浆D-二聚体、白细胞介素6(IL-6)及肿瘤坏死因子α(TNF-α)的动态变化及其对预后的影响。方法选择2008年1月至2010年1月本科住院的50例SIRS患者作为SIRS组,将其按是否发生多器官功能障碍综合征(MODS)分为单纯SIRS组(n=26)和MODS组(n=24);按预后分为存活组(n=35)和死亡组(n=15)。测定其SIRS发生后第1、3、5、7天患者血浆D-二聚体、IL-6和TNF-α含量,并记录APACHEⅡ评分;另选35例普通内科住院患者作为非SIRS组,30例健康者作为对照组。对SIRS患者血浆D-二聚体含量与APACHEⅡ评分、IL-6和TNF-α进行Pearson相关分析。结果单纯SIRS组和MODS组患者血浆D-二聚体、IL-6、TNF-α含量较非SIRS组和对照组显著升高(P<0.01)。SIRS发生后第3天与第1天比较,存活组与死亡组患者血浆D-二聚体含量的差异无统计学意义(P>0.05),SIRS发生后第5、7天,死亡组患者血浆D-二聚体含量明显高于存活组(P<0.05)。SIRS发生后第1、3、5、7天,存活组与死亡组患者血浆IL-6和TNF-α含量比较,差异有统计学意义(P<0.01)。SIRS患者D-二聚体含量与APACHEⅡ评分、IL-6、TNF-α含量呈正相关(r分别为0.453、0.342、0.340,P<0.01)。结论 IL-6、TNF-α参与SIRS患者的凝血功能障碍,D-二聚体与病情严重程度呈正相关;血浆持续高水平的D-二聚体、IL-6、TNF-α提示预后不良。

A study of dynamic changes of plasma D-dimer and cytokine of patients with systemic inflammatory response syndrome

Objective To explore the dynamic changes of plasma D-dimer,interleukin-6(IL-6) and tumor necrosis factor alpha(TNF-α) of patients with systemic inflammatory(SIRS) and their influences on prognosis.Methods 50 patients with SIRS hospitalized from January 2008 to January 2010 in our hospital served as SIRS group which was subdivided into simple SIRS group(n=26)and MODS group(n=24) according to whether MODS occurred,and subdivided into survival group(n=35) and death group(n=15),according to their prognosis.Their plasma D-dimer,IL-6 and TNF-α were detected on the 1st,3rd,5th and 7th day after SIRS occurred,and their APACHEⅡ scores were recorded.Another 35 patients hospitalized in general medicine department served as non-SIRS group and 30 healthy people served as control group.The relations between plasma contents of D-dimer and APACHEⅡ score,IL-6,TNF-α of patients with SIRS,respectively,were subjected to Pearson correlation analysis.Results The contents of plasma D-dimer,IL-6 and TNF-α of patients in simple SIRS group and MODS group were significantly increased when compared with non-SIRS group and control group(P<0.01).Compared with the 3rd day and the 1st day after SIRS occurred,plasma D-dimer content of patients in both survival group and death group showed no significant difference(P>0.05).Plasma D-dimer content of patients in death group was markedly higher than that in survival group(P<0.05).Compared the plasma contents of IL-6 and TNF-α of patients between survival group and death group on the 1st,3rd,5th and 7 th day after SIRS occurred,differences were found to be statistically significant(P<0.01).D-dimer content of patients with SIRS showed positive correlation with APACHEⅡ score,IL-6 and TNF-α contents(r=0.453,0.342,0.340,respectively,P<0.01).Conclusion IL-6 and TNF-α participate in coagulation disorder of patients with SIRS,D-dimer has positive correlation with disease severity,and sustaining high levels of plasma D-dimer,IL-6,TNF-α indicate a poor prognosis.