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[摘要] 目的探讨TNF-α和IL-6在重症急性胰腺炎(SAP)患者血清中的变化及临床意义。方法应用ELISA法检测32例重症急性胰腺炎及25例对照组血清TNF-α、IL-6的水平变化。结果入院时SAP患者TNF-α水平(48.5±12.1)pg/mL显著高于对照组(13.5±3.8)pg/mL,IL-6 水平SAP患者(66.7±19.3)pg/mL较对照组(42.3±14.2)pg/mL无明显升高;SAP患者血清IL-6在入院的第7天升高最明显(180.1±41.4)pg/mL,高于对照组,在入院第14天SAP患者血清TNF-α(29.5±9.5)pg/mL,IL-6 (102.8±24.6)pg/mL仍然高于对照组。结论检测血清TNF-α和IL-6的水平变化,对重症急性胰腺炎的早期诊断、病情判断和预后评估具有重要的应用价值。
[关键词] 重症急性胰腺炎;肿瘤坏死因子-α;白细胞介素-6
[中图分类号] R576 [文献标识码] A[文章编号] 1673-9701(2009)34-04-02
Dynamic Changes and Clinical Significance of Serum TNF-α and IL-6 in Severe Acute Pancreatitis
CHAI HulinWANG DeqiangLIU Tiejun
General Surgery,the First Affiliated Hospital of Baotou Medical College,Baotou 014010,China
[Abstract] ObjectiveTo investigate the changes and clinical significance of serum TNF-α and IL-6 in severe acute pancreatitis(SAP). MethodsThe serum levels of TNF-α and IL-6 in 32 cases of SAP and 25 normal controls were determined by EL ISA. Results On admission, the serum TNF-α level of the SAP group(48.5±12.1pg/mL) was significantly higher than that of the control group(13.5±3.8pg/mL),while the serum IL-6 level of the SAP group(66.7±19.3pg/mL)showed no significant difference from that of the control group compared with the control group(42.3±14.2pg/mL). The serum IL-6 level of the SAP group(180.1±41.4pg/mL) was significantly higher than that of the control group on Day 7 after admission;the serum levels of TNF-α and IL-6 in the SAP group (29.5±9.5pg/mL) and (102.8±24.6pg/mL) were significantly higher than those of the control group but there was no significant difference between the SAP group and the control group on Day 14 after treatment. ConclusionThe determination of the serum levels of TNF-α and IL-6 may be of great value for early diagnosis,judgment of severity and prognosis of severe acute pancreatitis.
[Key words] Severe acute pancreatitis;Tumor necrosis factor-α;Interleukin-6
重症急性胰腺炎(severe acute pancreatictis,SAP)是临床常见的急腹症,起病急,发病快,易引起全身多脏器功能损害,死亡率高[1,2]。人体在患SAP时,整个机体处于高分解代谢的应激状态,静态能量需求增加,分解代谢大于合成代谢,免疫功能减退,肠道菌群移位,导致胰腺坏死组织感染,最终导致器官衰竭。近年来,随着对SAP发病机制认识的不断深入,细胞因子在急性胰腺炎中的作用愈来愈受到人们的重视[3]。本研究测定了SAP患者血清中肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)含量,旨在探讨它们在重症急性胰腺炎患者血清中的变化情况,以及在诊断病情和预后判断中的意义。
1 资料与方法
1.1临床资料
本实验收集2007年1月～2009年2月包头医学院第一附属医院普外科、第二附属医院消化内科SAP患者32例,男21例,女11例;年龄为35～68岁,平均年龄为48.13岁。均符合急性胰腺炎诊断标准;根据中华医学会消化病学分会胰腺疾病学组制定的中国急性胰腺炎诊治指南草案急性胰腺炎的诊断标准为:临床上表现为急性、持续性腹痛(偶无腹痛),血清淀粉酶活性增高≥正常值上限3倍,影像学提示胰腺有或无形态改变,排除其他疾病者,APACHEⅡ评分≥8分;Bathazar评分为D、E级。入选正常对照组25例,男16例,女9例;年龄为32～52岁,平均年龄为41.2岁。
1.2检测方法
患者均于入院第1、3、7、14天分别抽取静脉血3mL;对照组仅于检查当日空腹抽取一次静脉血3mL。所有血标本经3000r/min离心10min,分离血清置-20℃保存待检。检测方法: TNF-α和IL-6均采用ELISA方法检测,严格按试剂盒(深圳晶美生物有限公司)说明书进行操作。
1.3统计学处理
所有数据用SPSS13.0统计软件包进行处理。计量资料以(χ±s)表示,组间比较采用t检验,以P0.05),见表1。
2.2IL-6水平动态变化
入院第1天两组患者血清IL-6水平与对照组比较无统计学意义(P>0.05);入院第7天两组血清IL-6水平均显著升高并达峰值,虽然分别于第14天降至对照组水平,但是仍然高于对照组(P>0.05)。见表1。
3讨论
SAP是临床上常见的急腹症之一,其主要特征是胰腺局部炎症和全身炎症反应[4],促炎性细胞因子在SAP发展过程中起重要作用,其中TNF-α和IL-6在胰腺炎症早期阶段即可大量释放。当患者合并严重感染出现内毒素血症时,这些炎症递质的释放更为强烈,产生更为严重的局部及全身炎症反应和组织损伤,可使胰腺炎从水肿型向坏死型发展。因此,监测血清中TNF-α和IL-6可以预测AP的严重程度,阻止炎症的初始反应可以减轻胰腺炎的病理变化[5]。另外,IL-6作为一种非常敏感的炎症反应标志物,与传统的炎症指标相比,IL-6有助于鉴别全身性感染和全身炎症反应综合症等病理状态[6]。
TNF-α主要由活化的单核-巨噬细胞产生,是一种具有多种生物学效应的生理炎性介质,可导致炎症、细胞坏死等,适量的TNF-α对机体有保护作用,过量时则会对机体产生损伤,它除对血管内皮细胞及炎性细胞具有直接的激活和毒性作用外,更主要的是诱导急性期蛋白的合成,催化和放大炎性反应,造成组织细胞的损害。本研究显示,入院时SAP患者TNF-α水平显著高于对照组水平,在第三天达到高峰,提示TNF-α水平升高较早,在SAP患者从轻型向重症的发展过程中起核心用。IL-6主要由单核巨噬细胞和内皮细胞分泌,是一种重要的急性反应期炎症介质。血清IL-6的水平和持续时间可反映急性胰腺炎的严重程度[7],所以IL-6是早期预测SAP预后、评价炎症严重程度的最有用的炎症参数之一[8]。临床研究显示SAP患者血清IL-6水平明显高于轻度患者,有并发症的胰腺炎患者血中IL-6水平显著高于无并发症的患者[9]。本研究显示,SAP血清IL-6在发病的第7天左右升高最明显,高于对照组,在发病的第14天左右(进行系统的治疗后,病情得到改善)SAP血清IL-6仍然高于对照组。提示IL-6既可作为急性胰腺炎早期诊断标志物,也是判断病情程度和评估预后重要指标。综上所述,联合检测SAP患者血清中TNF-α和IL-6的水平变化,对重症急性胰腺炎的早期诊断、病情判断和预后评估具有重要的应用价值。
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(收稿日期:2009-07-31)
