多发伤患者外周血单个核细胞NF-κB活性变化及乌司他丁的保护作用

摘要

目的 探讨多发伤患者早期外周血单个核细胞NF-κB活性变化及乌司他丁的保护作用.方法 收集2008-01~2010-05急诊收治20～55岁的多发伤患者,将入选的多发伤患者随机分为多发伤对照组、乌司他丁治疗组.乌司他丁治疗组在创伤后12 h内开始给予乌司他丁治疗,20万U溶于100 mL生理盐水中静脉注射,以后每8 h 1次,连续7 d.采集患者在入院时(0)、第1天、第2天、第3天、第4天及第7天外周静脉血.测定外周血单个核细胞NF-κB活性及血清TNF-α、IL-1、IL-6浓度.分析比较不同组患者实验室指标和临床指标的差异.结果 多发伤患者创伤后第1天(24 h)外周血单个核细胞NF-κB活性、血清IL-6、TNF-α浓度均最高,随后逐渐降低,至第3天(72 h)后降至正常.乌司他丁治疗组单个核细胞NF-κB活性、血清IL-6、TNF-α浓度均较对照组降低,但差异无统计学意义.多发伤患者SIRS平均持续(10±3.5)d,乌司他丁治疗组平均持续(7±3.1)d,两组比较差异有统计学意义(t=2.31,P=0.029).多发伤患者MODS平均持续(8.8±2.6)d,乌司他丁治疗组平均持续(5.6±2.7)d,两组差异有统计学意义(t=2.27,P=0.025).结论 多发伤患者早期单个核细胞NF-κB活性及血清前炎症细胞因子呈一过性升高.乌司他丁能缩短多发伤患者SIRS、MODS持续时间,但未发现能显著降低外周血单个核细胞NF-κB活性.%Objective To invesligale dynamic aclivily of NF - kB in multiple Lrauma patients in the early period and proleclive effects of Ulinastain. Methods Selecting multiple Lrauma patients who were admilled to emergency department and were 20 ～ 55 years old from January 2008 to May 2010, all enrolled patients were assigned randomty to control group and Ulinaslain group. The patients of Ulinastain group received 200 000 U of Ulinaslain with 100 mL of normal saline, every 8 hours for 7 days. NF - kB activity in monocytes and level of TNF - α, IL - 1, IL - 6 on admission ( d0 ) , d1, d2, d3, d4, d7 in serum were measured. Data were compared and analyzed belween different groups. Results NF - kB activity in monocytes and level of TNF - α, IL - 1, IL - 6 of mulliple patients reached peak at 24 h after lrauma, and decreased gradually, and became normal at 72 hour after trauma. NF - kB activity and level of TNF - α, IL - 1, IL - 6 in Ulinastain group were lower than conlrol group, but there were no significant difference between the two groups. The mean time of persisting SIRS and MODS were (7 ±3. 1) days and (10 ±3. 5) days in Ulinastain group and control group respectively, and showed significant difference. Conclusion NF - kB activity in monocytes and level of inflammatory cytokines in multiply injured patientls increased transiently in the early period of lrauma. Ulinaslain may shorten SIRS, MODS time, but doesn't show the ability of decreasing the activity of NF - kB.