重症胰腺炎 Fas/FasL 介导的胰腺细胞凋亡与 Th1/Th2偏移的临床研究

摘要

Objective To investigate the relationship between Fas/FasL mediated apoptosis and Th1/Th2 shift in serve acute pancreatitis. Methods The serum level of aFas,sCD4 in patients who were suffering acute pancreatitis were measured, the relationship between the serum level of aFas,sCD4 with the APACHE2 score and Balthazar CT serious index score were studied. The serum level of Th1/Th2 drift related cytokine in patients who were suffering acute pancreatitis were measured, the relationship between the serum level of Th1/Th2 shift related cytokine with the APACHE2 score and Balthazar CT serious index score were studied. Results Our study indicates that the reduction of CD4+ T cel is related to the severity of acute pancreatitis.The serum level of sCD4 is corrlated with the serum level of sFas in pacreatitis.The serum level of IL-4 and IL-10 is higher in the severe and mild pacreatitis group than the control group, The serum level of IL-4 and IFN-γhave obviously correlation with the severily of pancreatitis. Conclusion Immunological reaction was regarded as one of the important reasons for the death of severe acute pancreatitis patients .Exceeded inflammatory reaction was regarded as the most common reason of death. Lymphatic system played an important role in this procedure. Fas mediated abnormal cel apoptosis can obviously influenced serum level of cytokine, the possible mechanism maybe Fas mediated Th lymphocyte apoptosis.Th1/Th2 immunological shift has relations with acute pancreatitis. In the early stage of pancreatitis, the inflammatory reaction was in a dominant position, and afterwards, anti-inflammatory reaction was in a dominant position. This result is in accordance with the clinical feature of acute pancreatitis, has a important value in the clinical treatment of pancreatitis.%　　目的探讨急性重症胰腺炎 Fas/FasL 介导的胰腺细胞凋亡与 Th1/Th2偏移的关系。方法检测重症急性胰腺炎患者血清中 aFas 、SCD4浓度，对急性胰腺炎患者进行 APACHE2标准评分,BalthazarCT 严重指数评分，分析患者血清中 aFas、SCD4浓度与 APACHE2标准评分,BalthazarCT 严重指数评分的关系；检测重症急性胰腺炎患者血清中 Th1(IFNr、IL-2)/Th2(IL-4、IL-10)偏移相关的细胞因子水平，并探讨其与 APACHE2标准评分,BalthazarCT 严重指数评分的关系。结果提示 CD4+T 细胞的减少与胰腺炎的严重程度有关，胰腺炎 sCD4与 sFas 浓度之间存在明显相关性。重症胰腺炎及轻症胰腺炎组中 IL-4、IL-10水平均较对照组明显升高，胰腺炎 IL-4、IFN-γ浓度与胰腺炎严重程度存在明显相关性。结论对于重症胰腺炎来说，免疫系统是导致患者死亡的重要原因。过度的炎性反应，被认为是急性重症胰腺炎最常见的死因。淋巴细胞被认为在这个过程中发挥了重要作用。Fas 介导的异常的细胞凋亡能明显影响细胞因子，可能的机制可能是 Fas介导的 Th 细胞的凋亡。Th1/Th2细胞免疫漂移与急性胰腺炎有关，胰腺炎早期时炎症反应占优势，之后抗炎反应占优势，与临床上急性胰腺炎发病过程相符，对于临床治疗胰腺炎有一定指导意义。