严重腹腔感染机体免疫失衡与中医虚实证型关系的研究

作者	单位
傅强	天津医科大学天津市南开医院外科
崔乃强	天津医科大学天津市南开医院外科
喻文立	天津市第一中心医院麻醉科

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中文摘要:

目的研究严重腹腔感染所致多脏器功能障碍综合征(MODS)患者的免疫失衡特点与中医虚实证型的相关性。方法连续观察46例严重腹腔感染所致MODS,采用中西医结合方法,针对病因及辨证治疗,于入选后第1、3、7天测定外周血白细胞介素6/白细胞介素10比值(IL-6/IL-10)、人类白细胞抗原DR位点(HLA-DR)、T辅助淋巴细胞1/2(Th1/Th2比值)、调节性T淋巴细胞(Treg)水平,同时观察实证、虚实夹杂证、虚证等中医证型的分布规律。结果IL-6/IL-10比值在实证与虚实夹杂证各时间点比较,差异无统计学意义;虚证第7天较第1天下降,同期比较,实证、虚实夹杂证、虚证IL-6/IL-10比值依次降低。HLA-DR水平在实证、虚实夹杂证、虚证依次降低,实证及虚实夹杂证均未发现HLA-DR<30%的病例,在虚证患者中,第7天HLA-DR全部<30%,较第1天差异有统计学意义(P<0.05)。Th1/Th2比值在实证与虚证前3天差异无统计学意义,第7天较第1天出现下降,虚实夹杂证1周内无变化,同期比较,实证、虚实夹杂证、虚证Th1/Th2比值依次降低。Treg水平在实证与虚实夹杂证前3天差异无统计学意义,虚证第3天较第1天升高,第3天与第7天差异无统计学意义,同期比较,实证、虚实夹杂证、虚证Treg水平依次升高。结论在严重腹腔感染所致MODS病理过程中,反映机体促/抗炎细胞因子平衡的IL-6/IL-10比值及反映免疫功能的HLA-DR、Th1/Th2比值和Treg水平均能较为准确地反映中医虚实证型,表现为实证、虚实夹杂证、虚证时,IL-6/IL-10比值、HLA-DR和Th1/Th2依次下降,而Treg水平依次升高。

英文摘要:

Objective To explore the characteristics of immune imbalance in patients with multiple organ dysfunction syndrome(MODS) induced by severe intra-abdominal infection and its relationship with changing of TCM sthenia-asthenia syndrome.MethodsForty-six patients with MODS induced by severe intra-abdominal infection and treated with etiological and syndrome differentiation of integrative medicine were observed in succession.Patients′ peripheral blood levels of interleukin-6/interleukin-10 ratio(IL-6/IL-10),human leukocyte antigen DR site(HLA-DR),helper T lymphocyte1/2 ratio(Th1/Th2),and the regulatory T lymphocyte(Treg) were measured on the 1st,3rd and 7th day of the research respectively.And the distribution laws of TCM syndrome types,sthenia(S),asthenia(A),and mingled sthenia/asthenia(M),in patients were observed as well.ResultsIL-6/IL-10 ratio at all the testing time points showed insignificant difference in patients of types S and M,while in those of type A,it was more lowered on the 7th day than that on the 1st day.HLA-DR lowered to <30% on the 7th day in all patients of type A and showed significant difference to that on the 1st day(P<0.05),while HLA-DR<30% was not found in all patients of types S and M.Th1/Th2 ratio in patients of types S and A was insignificant different at the foremost 3 days,but lowered significantly on the 7th day,while in patients of type M,it was unchanged in all the 7days of observation.Treg level was unchanged in the foremost 3 days in patients of types S and M,while in those of type A,it raised on the 3rd day,but no raising was found in the subsequent 4 days.Comparisons of various indexes detected at corresponding time points respectively among patients with various syndrome types showed that,for levels of IL-6/IL-8,HLA-DR,and Th1/Th2,the sequence was S>M>A;and for Treg,it was A>M>S.ConclusionIn the pathological process of MODS induced by severe intra-abdominal infection,the index IL-6/IL-10,reflecting the balance of the pro-/anti-inflammatory cytokines and the indexes HLA-DR,Th1/Th2 and Treg reflecting the immune function,all can exactly reflect the TCM asthenia-sthenia syndrome types.The sequence in patients of various syndrome types for levels of IL-6/IL-10,HLA-DR and Th1/Th2,is S>M>A,but for Treg it is the inverse,as A>M>S.

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