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目的 探讨细胞因子在老年肾综合征出血热 (HFRS)发病中的作用。方法 检测 42例老年 HFRS患者血清中 IL- 6、IL- 2和 TNF含量。 PHA刺激体外培养的 HFRS患者外周血单个核细胞 (PBMC) ,观察产生 IL - 6、IL- 2和 TNF能力。将 HFRS患者血清加入正常的 PBMC进行体外培养 ,检测 IL - 6、IL- 2和 TNF的分泌量。结果 老年 HFRS患者血清 IL - 6、IL - 2和 TNF含量较对照组明显增高(P<0 .0 1 ) ,IL- 6、IL- 2的高峰值在少尿期 ,TNF的高峰值在低血压期。PHA刺激 HFRS患者 PBMC产生 IL- 6、IL- 2和 TNF在发热期已达高水平 ,低血压期、少尿期持续在高水平 ,多尿期开始下降。加入 HFRS患者血清后 ,正常人 PBMC在 PHA刺激下产生的 IL - 6、IL - 2和 TNF减少 ,特别是在少尿期与正常组比较减少更明显 (P<0 .0 5,P<0 .0 5,P<0 .0 1 )。结论 HFRS患者在发病初期 PBMC既处于活化状态 ,在发病过程中产生大量细胞因子 ,参与肾脏的免疫损伤。 HFRS患者血清中存在对 PBMC产生细胞因子有抑制作用的物质 ,细胞因子在免疫性损伤中的作用取决于 PBMC的分泌量与抑制物质的抑制的双重作用。
Objective To investigate the role of cytokines in the pathogenesis of hemorrhagic fever with renal syndrome (HFRS). Methods The serum levels of IL-6, IL-2 and TNF in 42 elderly HFRS patients were detected. Peripheral blood mononuclear cells (PBMC) from HFRS patients cultured in vitro were stimulated by PHA, and the ability of producing IL - 6, IL - 2 and TNF was observed. The serum of HFRS patients was added to normal PBMC for in vitro culture to detect the secretion of IL - 6, IL - 2 and TNF. Results Serum levels of IL - 6, IL - 2 and TNF in elderly patients with HFRS were significantly higher than those in control group (P <0.01). The peak values of IL - 6 and IL - Blood pressure period. The production of IL-6, IL-2 and TNF by PBMCs stimulated by PHA in HFRS patients reached high levels during the fever period, during hypotension, oliguria continued at high levels, polyuria began to decline. After addition of serum of HFRS patients, the levels of IL - 6, IL - 2 and TNF produced by PBMC in PHA group decreased significantly, especially in the oliguria phase (P <0.05, P <0 .0 5, P <0 .0 1). Conclusion In the early stage of HFRS, PBMCs are both activated and produce a large number of cytokines involved in the immune damage of the kidneys. The serum of HFRS patients have cytokine inhibitory effect on PBMC. The role of cytokines in immune damage depends on the dual role of PBMC secretion and inhibitory substance inhibition.