肿瘤坏死因子-α、内毒素、白细胞介素-6、磷脂酶A2与重症胸腹损伤急性肝功能障碍的相关性与机制探讨

摘要

Objective To investigate the effectiveness of tumor necrosis factor (TNF)-α,endotoxin,interleukin (IL)-6,phospholipase A2 (PLA2) in acute liver function disorders after severe chest-abdominal injury.Methods Eighty-two patients with severe chest-abdominal injury were collected as injury group,trauma index were all above or equal to 17 scores,and the patients who were complicated with craniocerebral injury and died in the emergency room were excepted.Alanine aminotransferase (ALT),aspartate aminotransferase (AST),TNF-α,endotoxin,IL-6 and PLA2 were examined in the rescue at the same time.These indicators were compared with 36 healthy examination subjects (control group).Correlation was analyzed by linear correlation.Results ALT,AST,TNF-α,endotoxin,IL-6,PLA2 in injury group were significantly higher than those in control group [(208.43 ± 41.35) U/L vs.(17.25 ± 4.48) U/L,(198.49 ±39.62) U/L vs.(18.29 ± 5.37) U/L,(36.41 ± 18.09) μ g/L vs.(1.28 ± 0.59) μ g/L,(343.66 ± 106.02) U/L vs.(87.38 ± 46.51) U/L,(393.83 ± 143.86) μ g/L vs.(63.93 ± 41.49) μ g/L,(41.35 ± 14.26) μ g/L vs.(7.47 ± 5.27) μμ g/L],there were statistical differences (P ＜ 0.01).There were positive correlation in severe chest-abdominal injury patients between ALT,AST and TNF-α,endotoxin,IL-6,PLA2 (r =0.9423 and 0.9643,0.8657 and 0.8860,0.9514 and 0.9326,0.9142 and 0.9618,P ＜0.01).Conclusions TNF-α,endotoxin,IL-6 and PLA2 all participate in the process of the acute liver function disorders in severe chestabdominal injury.The prophase interference in TNF-α,endotoxin,IL-6,PLA2 is possible to improve the liver function disorders in severe chest-abdominal injury.%目的 探讨肿瘤坏死因子(TNF)-α、内毒素、白细胞介素(IL)-6、磷脂酶A2(PLA2)在重症胸腹损伤急性肝功能障碍发生过程中的作用.方法 收集创伤指数≥17分、除外合并颅脑损伤及在急诊死亡的胸腹损伤患者82例(损伤组),在救治同时抽血检查丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、TNF-α、内毒素、IL-6和PLA2,并与36例健康体检者(对照组)进行比较.采用线性相关进行相关性分析.结果 损伤组ALT、AST、TNF-α、内毒素、IL-6、PLA2均明显高于对照组[(208.43±41.35) U/L 比(17.25±4.48) U/L、(198.49±39.62) U/L比(18.29±5.37) U/L、(36.41±18.09) μg/L比(1.28±0.59) μg/L、(343.66±106.02) U/L比(87.38±46.51) U/L、(393.83±143.86)μg/L比(63.93±41.49)μg/L、(41.35±14.26)μg/L比(7.47±5.27) μg/L],差异有统计学意义(P＜0.01).重症胸腹损伤患者ALT和AST与TNF-α、内毒素、IL-6、PLA2均呈正相关(r=0.9423和0.9643、0.8657和0.8860、0.9514和0.9326、0.9142和0.9618,P＜0.01).结论 TNF-α、内毒素、IL-6、PLA2均参与了重症胸腹损伤后急性肝功能障碍的发生、发展.急诊救治重症胸腹损伤患者时,应对TNF-α、内毒素、IL-6、PLA2进行早期干预,或有可能抑制急性肝功能障碍的发生或减轻其严重程度.