多器官功能障碍综合征患者血清sFas和sFasL浓度的变化

目的探讨多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）患者血清sFas和sFasL浓度在MODS诊断以及病情严重程度和预后判断中的临床意义以及与血清肿瘤坏死因子-α（TNF-α）水平的相关性。方法采用酶联免疫吸附法（ELISA）测定36例MODS患者血清sFas、sFasL和TNF-α浓度，以急性生理学与慢性健康状况评分系统Ⅲ（APACHEⅢ）评分和改良MODS评分评估病情严重程度，比较MODS组与对照组[包括非全身炎症反应综合征（SIRS）对照组和健康对照组]以及MODS组内死亡和存活患者之间血清sFas、sFasL浓度的差异，分析患者血清sFas、sFasL和TNF-α浓度与病情严重程度及血清sFas和sFasL与TNF-α浓度的相关性。结果MODS患者血清sFas、sFasL浓度均明显高于非SIRS对照组和健康对照组（P〈0．05或P〈0．01），且与病情严重度评分均呈正相关（P均〈0．01）。MODS患者中死亡组较存活组血清sFas、sFasL浓度明显升高（P均〈0．05）。MODS患者血清TNF-α浓度较非SIRS对照组和健康对照组明显增高，并与MODS组血清sFas、sFasL浓度呈高度正相关（P均〈0．01）。MODS患者血清sFas、sFasL浓度随器官衰竭个数增加而升高。结论血清sFas、sFasL可用于临床MODS辅助诊断和协助判断病情严重程度及预后。TNF-α可能促进了MODS中Fas／FasL系统表达上调。

Change in serum levels of soluble Fas and soluble FasL in patients with multiple organ dysfunction syndrome

OBJECTIVE: To evaluate the significance of changes in the serum levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in patients with multiple organ dysfunction syndrome (MODS) regarding its diagnosis and judgement of severity and outcome, and to investigate the correlations between the levels of tumor necrosis factor-alpha (TNF-alpha), sFas and sFasL. METHODS: Enzyme linked immunoadsorbent assay (ELISA) was used in the determination of serum sFas, sFasL and TNF-alpha in 36 patients with MODS. Thirty-two non SIRS patients and 20 healthy individuals comprised the control groups. The acute physiology and chronic health evaluationIII (APACHE III) scoring system and modified MODS scoring system were used to assess patients' clinical severity. The differences of sFas and sFasL levels between MODS group and control groups and between survival and dead patients were observed. The correlations between sFas, sFasL and TNF-alpha levels and severity of MODS and the correlations between the TNF-alpha levels and the levels of sFas and sFasL were also observed. RESULTS: The serum levels of sFas, sFasL and TNF-alpha in patients with MODS were significantly higher than those in controls (P<0.05 or P<0.01), and were associated with severity of the disease (all P<0.01) . The sFas and sFasL levels were found to be significantly higher in the patients who eventually died as compared to those in the patients who survived (both P<0.05). Positive correlations were noted between the TNF-alpha levels and the levels of sFas and sFasL(both P<0.01). The serum levels of sFas and sFasL were elevated with the increase of the number of failure organs in MODS patients. CONCLUSION: The serum levels of sFas and sFasL may serve as diagnostic and prognostic indicators for MODS. TNF-alpha may help enhance the expression of Fas/FasL system.