多器官功能障碍综合征患者中性粒细胞功能的变化

发布时间：2018-03-01 04:27

本文关键词：全身炎症反应综合征多器官功能障碍综合征中性粒细胞弹性蛋白酶髓过氧化物酶活性白介素8 肿瘤坏死因子α 流式细胞仪急性生理与慢性健康状况评估Ⅲ　出处：《第二军医大学》2006年硕士论文　论文类型：学位论文

【摘要】：目的:研究多器官功能障碍综合征患者病情发展不同阶段(SIRS期和MODS期)中性粒细胞功能的变化,探讨中性粒细胞在MODS病情演进中的作用。材料与方法:10例我院加强医疗病房(ICU)收治的具有明显SIRS和MODS分期的MODS患者为研究对象。其中男性5例,女性5例,平均年龄59.8岁,包括上消化道穿孔术后3例,多发伤术后2例,肠梗阻术后3例,化脓性胆管炎术后2例。分别在SIRS期和MODS期,取外周静脉血3ml,肝素抗凝,采用流式细胞仪检测其外周血中性粒细胞功能:①中性粒细胞在化学趋化三肽fMLP刺激下趋化通过3μm细胞池滤膜的功能;②中性粒细胞吞噬经调理的大肠埃希菌的功能;③中性粒细胞在大肠埃希菌刺激下发生氧化呼吸爆发的功能。分析中性粒细胞功能变化与MODS患者病情演进的关系。采用酶联免疫吸附法(ELISA法)动态检测患者不同时期血清TNF-α、IL-8水平的变化;采用比色法分别检测疾病不同时期患者血浆中性粒细胞弹性蛋白酶活性;分别于SIRS期和MODS期抽取外周静脉血2ml,应用ADVIA 120全自动血细胞分析仪全血法测定中性粒细胞髓过氧化物酶活性指数;采用硝酸还原酶法测定不同时期患者血浆NO浓度。8例健康志愿者平均年龄27.2±4.3岁,其中男性6例,女性2例,均无慢性炎症病史,在抽血前1月无急性炎症发作病史。抽取外周静脉血15ml,按照上述方法测定各指标作为正常值参照。运用软件动态分析随着病情进展患者血浆各细胞因子水平变化情况并分析血浆NO水平变化与中性粒细胞功能变化的相关性。结果:①PMN的功能变化:与健康对照组相比,SIRS期患者外周血中性粒细胞的趋化、吞噬、氧化呼吸爆发功能均明显增强(P0.01),而MODS期患者外周血中性粒细胞趋化、吞噬功能减弱(P0.01),但呼吸爆发功能持续增强,且高于SIRS期(P0.01)。②血清中性粒细胞弹性蛋白酶活性随着病情的发展逐渐增强,即MODS期SIRS期健康对照组。SIRS组、MODS组与健康对照组比,差异显著(P0.01)。MODS组与SIRS组比,差异显著(P0.01)。③所有健康志愿者中性粒细胞髓过氧化物酶指数(MPXI)都在±10范围内,SIRS期患者的MPXI在+20～+30范围内,MODS期患者的MPXI均大于+30,说明随着病情的发展,中性粒细胞髓
[Abstract]:Aim: to study the changes of neutrophil function in patients with multiple organ dysfunction syndrome (MDS) in different stages of disease development, and to explore the role of neutrophils in the progression of MODS. Materials and methods Ten cases of MODS patients with obvious SIRS and MODS staging were studied, including 5 males and 5 females, with an average age of 59.8 years, including 3 patients with upper gastrointestinal perforation. There were 2 cases of multiple injury, 3 cases of intestinal obstruction and 2 cases of suppurative cholangitis after operation. Flow cytometry was used to detect the function of neutrophil function: 1 in peripheral blood stimulated by chemotactic tripeptide fMLP. The function of neutrophilic granulocyte phagocytosis of regulated Escherichia coli through 3 渭 m cell filter membrane was determined by flow cytometry. The function of neutrophils in oxidative respiratory burst induced by Escherichia coli was analyzed. The relationship between the changes of neutrophil function and the progression of MODS was analyzed. The dynamic detection of neutrophils in patients with MODS was performed by enzyme-linked immunosorbent assay (Elisa). The changes of serum TNF- 伪 and IL-8 levels during the period; The plasma neutrophil elastase activity was detected by colorimetry in patients with different stages of disease. Peripheral venous blood was collected from SIRS phase and MODS phase, and the myeloperoxidase activity index of neutrophils was measured by ADVIA 120 automatic blood analyzer. The mean age of plasma no concentration was 27.2 卤4.3 years old in 8 healthy volunteers, including 6 males and 2 females, all of whom had no history of chronic inflammation. There was no history of acute inflammatory attack on January before blood sampling. 15 ml of peripheral venous blood was extracted and measured as a normal reference according to the above method. Dynamic analysis of plasma cytokines levels was used to analyze the changes of plasma cytokines with the progression of the disease. The relationship between plasma no level and neutrophil function was analyzed. Results compared with the control group, the neutrophil chemotaxis, phagocytosis and oxidative respiratory burst function of neutrophils in patients with Sirs were significantly increased, while in patients with MODS, the neutrophil chemotaxis in peripheral blood was observed. The phagocytic function was weakened (P 0.01), but the respiratory burst function was continuously enhanced, and the activity of neutrophil elastase in serum was higher than that in the SIRS phase. The activity of neutrophil elastase increased gradually with the development of the disease, that is, the ratio of mods group to the healthy control group in the SIRS phase of MODS phase. Sirs group was higher than that in the healthy control group. Compared with SIRS group, there was a significant difference between P0.01mods group and SIRS group. All the healthy volunteers showed that the MPXI of Sirs patients in the range of 卤10 was more than 30 in the range of 20 ~ 30, indicating that the MPXI of patients with mods was more than 30 in the range of 卤10, indicating that the MPXI of patients with mods was more than 30 in the range of 20 ~ 30, which indicated that the MPXI of patients with mods was more than 30 in the range of 卤10. Neutrophil pulp
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R365

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