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目的:探讨糖尿病酮症酸中毒合并全身炎症反应综合征(SIRS)患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)含量的动态变化及其临床意义。方法:42例糖尿病酮症酸中毒患者为SIRS组18例和non-SIRS组24例。分别于发病24h内及3、7、14天晨起空腹抽取静脉血,采用放射免疫法(RIA)测定血清TNF-α、IL-10水平,并观察2组患者的多器官功能障碍综合征(MODS)发生率及死亡率。结果:non-SIRS组发病24h及3、7、14天不同时间血清TNF-α比较,差异有显著性意义(F=2.852,P=0.039);SIRS组不同时间血清TNF-α比较,差异有显著性意义(F=3.341,P=0.022);各时间点SIRS组血清TNF-α水平均明显高于non-SIRS组(P=0.000)。non-SIRS组发病24h及3、7、14天不同时间血清IL-10比较,差异有显著性意义(F=13.379,P=0.000);SIRS组不同时间血清IL-10比较,差异也有显著性意义(F=23.273,P=0.000);2组在3天时IL-10达到高峰,以后随着时间而逐渐下降,发病24h及3、7、14天时SIRS组血清IL-10均明显高于non-SIRS组(P<0.05)。SIRS组患者的死亡率高达11.11%(2/18),而non-SIRS组患者死亡率仅4.2%(1/24),2组比较,差异有显著性意义(Z=-5.695,P<0.01);SIRS组患者中有61.11%(11/18)出现MODS,non-SIRS组中有20.83%(5/24)出现MODS,差异有显著性意义(Z=-2.628,P<0.01)。结论:TNF-α及IL-10参与了糖尿病酮症酸中毒的发生、发展病理生理过程,具有预测价值。
Objective: To investigate the dynamic changes of serum tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) in patients with diabetic ketoacidosis complicated with systemic inflammatory response syndrome (SIRS) and its clinical significance. Methods: Twenty-four patients with diabetic ketoacidosis were SIRS patients and 24 non-SIRS patients. Venous blood was collected from fasting 24h and 3, 7 and 14 days respectively. Serum levels of TNF-α and IL-10 were measured by radioimmunoassay (RIA), and multiple organ dysfunction syndrome MODS) incidence and mortality. Results: There was significant difference in serum TNF-α at 24 hours, 3,7,14 days in non-SIRS group (F = 2.852, P = 0.039). There was significant difference in serum TNF- (F = 3.341, P = 0.022). The levels of serum TNF-α in SIRS group were significantly higher than those in non-SIRS group at each time point (P = 0.000). Serum IL-10 in non-SIRS group was significantly higher than that in other groups (F = 13.379, P = 0.000) at 24 h, 3, 7 and 14 days. The difference of serum IL-10 in SIRS group was also significant (F = 23.273, P = 0.000). IL-10 peaked at 3 days in group 2 and then decreased gradually with time. The levels of IL-10 in SIRS group were significantly higher than those at non-onset -SIRS group (P <0.05). In the SIRS group, the mortality rate was 11.11% (2/18) in the SIRS group and 4.2% (1/24) in the non-SIRS group. There was significant difference between the two groups (Z = -5.695, P <0.01) ). MODS occurred in 61.11% (11/18) of patients in SIRS group and MODS in 20.83% (5/24) patients in non-SIRS group. The difference was significant (Z = -2.628, P <0.01). CONCLUSION: TNF-α and IL-10 are involved in the pathogenesis of diabetic ketoacidosis and the development of pathophysiological processes with predictive value.