中重度ARDS时去甲肾上腺素与TNF-α IL-1βIL-9 IL-15的关系研究

doi:10.3969/j.issn.1002-1949.2018.12.015

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摘要目的通过研究中重度急性呼吸窘迫综合征（ARDS）患者第1天与第3天血清去甲肾上腺素（NE）水平与TNF-α、IL-1β、IL-9、IL-15水平的关系，探讨ARDS的神经免疫相关发病机制。方法选择2013-06～2015-11新疆医科大学第一附属医院急诊科中重度ARDS患者28例为病例组，随访28 d，根据预后是否存活分为死亡组（n=15）和存活组（n=13）。选择22例健康体检者作为对照组，分别检测病例组发病第1天、第3天及对照组第1天的血清NE、TNF-α、IL-1β、IL-9、IL-15水平，进行数据统计分析。结果病例组第1天及第3天TNF-α、 IL-1β、IL-9、IL-15、NE水平均高于对照组（P＜0.05）。相关性分析中病例组第1天 NE与TNF-α、IL-1β、IL-9呈正相关（P＜0.05，r＞0），与IL-15呈负相关（P＜0.05，r＜0）；第3天TNF-α与NE呈正相关（P＜0.05，r＞0）。发病第1天死亡组IL-9（4.45±0.51）、IL-15(115.37±18.59)和NE(18.45±3.23)pg/mL水平高于存活组［3.88±0.33、88.69±12.35、（17.97±3.35）pg/mL，P＞0.05］，死亡组TNF-α（219.57±35.36）和IL-1β(197.16±32.27)水平明显高于存活组［168.42±21.96，138.05±24.73，P＜0.05］。Logistic回归分析，TNF-α（OR=1.004，95%CI2.18~10.25，P=0.003）和IL-1β（OR=1.005，95%CI1.79~8.69，P=0.013）是影响ARDS预后的危险因素。结论在中重度ARDS早期交感神经递质释放与炎症反应程度基本一致，因此在临床抗炎治疗诊疗过程中应重视交感神经活性的变化。

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	柴亚歌
	彭鹏
	李雯莉
	杨建中

关键词 ：急性呼吸窘迫综合征(ARDS), 去甲肾上腺素(NE), 炎症因子

通讯作者: 杨建中（1976-），男，博士，E-mail：yjz6542@126.com。

作者简介: 柴亚歌（1989-），女，硕士，E-mail:1040835889@qq.com。

引用本文:

柴亚歌，彭鹏，李雯莉，杨建中. 中重度ARDS时去甲肾上腺素与TNF-α IL-1βIL-9 IL-15的关系研究[J]. 中国急救医学, 2018, 38(12): 1086-1090.
Chai Ya-ge, Peng Peng, Li Wen-li, Yang Jian-zhong. The study of the relationship between norepinephrine and TNF-α IL-1β IL-9 and IL-15 in critical ARDS. Chinese Journal of Critical Care Medicine, 2018, 38(12): 1086-1090.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.12.015 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I12/1086

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