严重脑外伤患者血浆内毒素和肿瘤坏死因子水平变化与多器官功能障碍综合征的关系

目的 :探讨血浆内毒素 (L PS)及肿瘤坏死因子 (TNF)在严重颅脑外伤后多器官功能障碍综合征(MODS)发生发展中的作用和机制及其临床意义。方法 :应用动态浊度法及放射免疫法动态监测 6 8例严重颅脑外伤患者血浆 L PS及 TNF的水平变化 ,比较 MODS组与非 MODS组及正常对照组 L PS及 TNF的变化。结果 :6 8例患者血浆 L PS及 TNF水平均明显升高 ,较正常对照组差异非常显著 (P均 <0 .0 1) ,且血浆高水平持续较长时间 ,MODS组升高的峰值较非 MODS组更显著 (P<0 .0 5和 P<0 .0 1)。结论 :重型颅脑外伤后早期即可导致内毒素血症的发生 ,内毒素可能是导致炎性介质产生和释放的重要机制之一 ;血浆 L PS与 TNF的高水平可能参与了严重颅脑外伤后 MODS的发病过程。

The relationship between the changes in plasma endotoxin,tumor necrosis factor levels and multiple organ dysfunction syndrome in patients with severe brain injury

Objective:To investigate the clinical significance and potential mechanism of plasma endotoxin and tumor necrosis factor (TNF) in the pathogenesis of multiple organ dysfunction syndrome (MODS) associated with severe brain injury.Methods:Plasma endotoxin and TNF levels in 68 patients with severe brain injury were detected dynamically by dynamic turbidity and radioimmunoassay,respectively.Results:Plasma endotoxin and TNF levels were elevated obviously and kept in high level in all 68 cases,and there were significantly different between patients with severe brain injury and normal controls (all P <0 01).Also,peak values in MODS group were markedly higher than that in nonMODS group ( P <0 05 and P <0 01).Conclusions:Endotoxemia may occure in early period of severe brain injury,and endotoxin may be one of important factors resulting in the release of inflammatory mediators.High levels of endotoxin and TNF may be involved in the development of MODS following severe brain injury.