摘要
目的通过研究中重度急性呼吸窘迫综合征(ARDS)患者第1天与第3天血清去甲肾上腺素(NE)水平与TNF-α、IL-1β、IL-9、IL-15水平的关系,探讨ARDS的神经免疫相关发病机制。方法选择2013-06~2015-11新疆医科大学第一附属医院急诊科中重度ARDS患者28例为病例组,随访28d,根据预后是否存活分为死亡组(n=15)和存活组(n=13)。选择22例健康体检者作为对照组,分别检测病例组发病第1天、第3天及对照组第1天的血清NE、TNF-α、IL-1β、IL-9、IL-15水平,进行数据统计分析。结果病例组第1天及第3天TNF-α、IL-1β、IL-9、IL-15、NE水平均高于对照组(P<0.05)。相关性分析中病例组第1天NE与TNF-α、IL-1β、IL-9呈正相关(P<0.05,r>0),与IL-15呈负相关(P<0.05,r<0);第3天TNF-α与NE呈正相关(P<0.05,r>0)。发病第1天死亡组IL-9(4.45±0.51)、IL-15(115.37±18.59)和NE(18.45±3.23)pg/mL水平高于存活组[3.88±0.33、88.69±12.35、(17.97±3.35)pg/mL,P>0.05],死亡组TNF-α(219.57±35.36)和IL-1β(197.16±32.27)水平明显高于存活组[168.42±21.96,138.05±24.73,P<0.05]。Logistie回归分析,TNF-α(OR=1.004,95%CI 2.18~10.25,P=0.003)和IL-1β(OR=1.005,95%CI 1.79~8.69,P=0.013)是影响ARDS预后的危险因素。结论在中重度ARDS早期交感神经递质释放与炎症反应程度基本一致,因此在临床抗炎治疗诊疗过程中应重视交感神经活性的变化。
Objective Through the relationship study of TNF -α,IL -1β,IL-9,IL -15 and norepinephrine (NE)in the patients on the first day and the third day when they had been diagnosed as acute respiratory distress syndrome (ARDS),we aim to explore the neuro -immune pathogenesis of ARDS.Methods We had chosen 28ARDS patients as the case group between June 2013 to November 2015 from the Department of Emergency of the First Affiliated Hospital of Xinjiang Medical University. According to the survival of patients after the twenty -eighth day,we also divided the case group into non -survival group (n =15)and survival group (n =13).And we had chosen 22healthy people as the control group.We respectively tested the plasma NE,TNF-α,IL-1β,IL-9and IL-15 concentration in the case group on the first day and the third day,and tested the same index in the control group on the first day.And then we analyzed the data.Results On the first day and the third day,the level of IL -113,IL -9,IL -15,NE was higher than that of the control group (P <0.05). On the first day NE showed a positive correlation with the TNF-α,IL-1β,IL -9(P <0.05,r >0), and a negative correlation with the IL-15(P <0.05,r <0);on the third day NE showed a positive correlation with the TNF -α (P <0.05,r >0).On the first day the level of the non -survival group about IL -9(4.45±0.51),IL -15(115.37±18.59)and NE (18.45±3.23)pg/mL was higher than that of the survival group [3.88±0.33,88.69±12.35,(17.97±3.35)pg/mL,P >0.05],the TNF -α (219.57±35.36)and IL-113(197.16±32.27)level of non -survival group was distinctly higher than that of the survival group (168.42±21.96,138.05±24.73,P <0.05).Logistic regression analysis showed that TNF-α(OR =1.004,95%CI 2.18±10.25,P =0.003)and IL -113(OR = 1.005,95%CI 1.79±8.69,P =0.013)were the risk factors that affected the prognosis of ARDS. Conclusion The SNS transmitters releasing is correlated to the change of the inflammatory factors. Therefore,in the course of clinical diagnosis and treatment,we should pay more attention to the activity changes of sympathetic nerve.
作者
柴亚歌
彭鹏
李雯莉
杨建中
Chai Ya -ge;Peng Peng;Li Wen -li;Yang Jian -zhong(Department of Emergency,the First Affiliated Hospital of Xinjiang Medical University,Urumchi 830054,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2018年第12期1086-1090,共5页
Chinese Journal of Critical Care Medicine
