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目的探讨血清可溶性TNF-α、IL-1β、转化生长因子-β1(TGF-β1)、E-选择素(E-sel)和L-选择素(L-sel)在肾综合征出血热(HFRS)发病机制中的作用。方法41例HFRS患者(轻症组22例,重症组19例)纳入研究,按病期采血。分别采用放射免疫法检测TNF-α、IL-1β,ELISA法检测TGF-β1、E-sel和L-sel,自动生化仪检测肝、肾功能和PLT计数。结果从发热期至多尿期,血清IL-1β、TNF-α、E-sel和L-sel水平均升高,其峰值与对照组比较,分别为(0.56±0.10)μg/L比(0.19±0.06)μg/L、(2.41±1.61)μg/L比(0.82±0.16)μg/L、(198.4±29.2)μg/L比(56.4±25.8)μg/L、(1372.5±137.3)μg/L比(1089.9±137.9)μg/L,差异有统计学意义(P值均<0.01)。动态观察,上述细胞因子和粘附分子的变化曲线与ALT、BUN的变化趋势一致。血清TGF-β1、TGF-β1/ IL-1β和TGF-β1/TNF-α比值在病程前三期均显著降低,与PLT的变化趋势相似。结论HFRS急性期血清IL-1β、E-sel、L-sel升高和TGF-β1水平下降是造成失控性全身炎性反应和肝、肾功能损害的重要因素,在HFRS发病机制中起重要作用;合理的对症治疗和适量使用免疫调节剂可改善预后。
Objective To investigate the effects of serum soluble TNF-α, IL-1β, TGF-β1, E-sel and L-sel on hemorrhagic fever with renal syndrome ) Pathogenesis in the role. Methods 41 cases of HFRS patients (22 cases of mild, severe group of 19 cases) were included in the study, according to the stage of blood collection. The levels of TNF-αand IL-1βwere detected by radioimmunoassay, the expressions of TGF-β1, E-sel and L-sel were detected by ELISA, and the liver and kidney function and PLT count were detected by automatic biochemical analyzer. Results The levels of serum IL-1β, TNF-α, E-sel and L-sel increased from fever to polyuria, and the peak values were (0.56 ± 0.10) μg / L and 0.06 μg / L, 2.41 ± 1.61 μg / L vs 0.82 ± 0.16 μg / L, 198.4 ± 29.2 μg / L vs 56.4 ± 25.8 μg / L, (1089.9 ± 137.9) μg / L, the difference was statistically significant (P <0.01). Dynamic observation, the changes of cytokines and adhesion molecules curve consistent with ALT, BUN trends. Serum TGF-β1, TGF-β1 / IL-1β and TGF-β1 / TNF-α ratio in the first three stages were significantly reduced, similar to the trend of PLT. Conclusions Elevated serum levels of IL-1β, E-sel, L-sel and decreased TGF-β1 in the acute stage of HFRS are important factors that cause uncontrolled systemic inflammatory response and impaired liver and renal function, which play an important role in the pathogenesis of HFRS ; Reasonable symptomatic treatment and moderate use of immunomodulators can improve the prognosis.