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目的:研究单核细胞趋化蛋白-1、E-选择素、细胞间黏附分子-1、γ-干扰素和白细胞介素-10在肾综合征出血热发病机制中的作用。方法:29例肾综合征出血热患者按病情分为2组,其中轻症组15例,重症组14例,另选20例健康者作对照。每例均分别在发热期、低血压少尿期、多尿期和恢复期采血,用ELISA方法检测血清单核细胞趋化蛋白-1、E-选择素、细胞间黏附分子-1和γ-干扰素含量,用放射免疫法检测白细胞介素-10,并同时行肝、肾功能和血常规检查。结果:从发热期至多尿期,血清单核细胞趋化蛋白-1、E-选择素、细胞间黏附分子-1、γ-干扰素均明显高于对照组,至恢复期则逐渐趋向正常,其变化曲线与谷丙转氨酶、尿素氮的变化趋势相似,而与血小板计数的变化趋势相反;血清白细胞介素-10在病程前四期增高;轻、重2组急性期γ-干扰素/白细胞介素-10比值均明显升高,2组峰值分别为0.45±0.75和0.23±0.25,与对照组0.12±0.16比较,差异有统计学意义(P<0.01)。结论:肾综合征出血热急性期血清单核细胞趋化蛋白-1、γ-干扰素、E-选择素、细胞间黏附分子-1以及γ-干扰素/白细胞介素-10比值均明显升高,且与肝、肾损害呈相关性,提示趋化因子与黏附分子之过度表达,加上TH1/TH2失平衡,在肾综合征出血热发病机制中起着重要的作用;合理的对症治疗和适量使用免疫调节剂可望改善本病的预后。
AIM: To investigate the role of monocyte chemoattractant protein-1, E-selectin, intercellular adhesion molecule-1, interferon-γ and interleukin-10 in the pathogenesis of hemorrhagic fever with renal syndrome. Methods: Twenty-nine patients with hemorrhagic fever with renal syndrome were divided into two groups according to their illness: 15 cases were mild, 14 cases were severe, and 20 cases were healthy. In each case, blood samples were collected during the period of fever, hypotension oliguria, polyuria and convalescence respectively. Serum levels of monocyte chemoattractant protein-1, E-selectin, intercellular adhesion molecule-1 and γ- Interferon content, radioimmunoassay detection of interleukin -10, and simultaneous liver and kidney function and blood tests. Results: From the period of fever to polyuria, serum monocyte chemoattractant protein-1, E-selectin, intercellular adhesion molecule-1 and interferon-gamma were significantly higher than those in the control group, The change curve was similar to that of alanine aminotransferase and urea nitrogen, but opposite to that of platelet count. Serum interleukin-10 was increased in the first four stages of the course of disease. The levels of γ-interferon / leukocyte The ratios of IL-10 and IL-10 in the two groups were significantly higher than those in the control group (0.45 ± 0.75 and 0.23 ± 0.25, respectively) (P <0.01). Conclusion: The ratios of serum monocyte chemoattractant protein-1, interferon-γ, E-selectin, intercellular adhesion molecule-1 and IFN-γ / IL-10 in patients with hemorrhagic fever with renal syndrome were significantly increased High, and liver and kidney damage were correlated, suggesting that chemokine and adhesion molecule overexpression, coupled with imbalance of TH1 / TH2, plays an important role in the pathogenesis of hemorrhagic fever with renal syndrome; reasonable symptomatic treatment And moderate use of immunomodulators is expected to improve the prognosis of the disease.