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目的探讨血清分泌型磷脂酶A2(sPLA2)及其水解产物血栓素A2(TXA2)和前列环素(PGI2)在儿童全身炎症反应综合征(SIRS)中的作用及意义。方法分别用ELISA法及RIA法检测54例患儿及22例健康儿童血清sPLA2、血浆血栓素B2(TXB2,系TXA2的稳定代谢产物)及6?酮?前列腺素(6?Keto?PGF1α,系PGI2的稳定代谢产物)的水平,并结合儿童危重评分(PCIS)监测患儿脏器功能。结果血清sPLA2、血浆TXB2水平在SIRS组明显高于对照组(P<0.01);在疾病恶化及死亡组明显高于好转及治愈组(P<0.01);PCIS≤70分组较71～89分组的sPLA2、TXB2水平明显增高(P<0.05,P<0.01);多脏器功能衰竭(MSOF)组较单脏器功能衰竭组明显增高;相应地,血浆6?Keto?PGF1α水平在SIRS组明显低于对照组,死亡组低于治愈组,MSOF组低于单衰组,高危重评分组低于低危重评分组(P<0.05或P<0.01)。血清sPLA2与血浆TXB2及脏器衰竭数呈正相关,与6?Keto?PGF1α及危重评分呈负相关。结论sPLA2、TXB2、6?Keto?PGF1α作为强烈致炎因子在儿童全身炎症反应综合征的发生发展过程中起重要作用,动态监测血清sPLA2、血浆TXA2及PGI2并结合危重评分对SIRS的病情轻重及预后的评估有重要的意义,为今后应用sPLA2抑制剂及环氧化酶抑制剂防治SIRS的发展提供了理论依据。
Objective To investigate the role and significance of serum secreted phospholipase A2 (sPLA2) and its hydrolyzate TXA2 and PGI2 in children with systemic inflammatory response syndrome (SIRS). Methods Serum levels of sPLA2, TXB2, a stable metabolite of TXA2 and 6? Ketoprostaglandin (6? Keto? PGF1?) In 54 children and 22 healthy children were detected by ELISA and RIA respectively PGI2 stable metabolites) levels, combined with children’s critical mass score (PCIS) monitoring organ function in children. Results Serum levels of sPLA2 and TXB2 in SIRS group were significantly higher than those in control group (P <0.01), and were significantly higher in disease progression and death group than those in control group and cure group (P <0.01) sPLA2 and TXB2 levels were significantly higher in MSOF group than those in single organ failure group (P <0.05, P <0.01). Correspondingly, the plasma level of 6? Keto? PGF1α was significantly lower in SIRS group In the control group, the death group was lower than the cure group, the MSOF group was lower than the single failure group, and the high-risk group was lower than the low-risk group (P <0.05 or P <0.01). Serum sPLA2 and plasma TXB2 and organ failure was positively correlated with 6? Keto? PGF1? And the risk score was negatively correlated. Conclusion sPLA2, TXB2 and 6? Keto? PGF1α play an important role in the pathogenesis of systemic inflammatory response syndrome in children. Dynamic monitoring of serum sPLA2, TXA2 and PGI2 in plasma, The evaluation of the prognosis is of great significance for the future application of sPLA2 inhibitors and cyclooxygenase inhibitors provide a theoretical basis for the prevention and treatment of SIRS.