海蜇蜇伤患者血清细胞因子及HIS、5-HT变化的研究

发布时间：2018-04-24 00:17

本文选题：海蜇蜇伤 + 细胞因子　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:通过检测海蜇蜇伤患者血清细胞因子及HIS、5-HT的变化,探讨海蜇蜇伤的发病机制,进而评估预后及指导治疗。方法:本研究采用单中心、前瞻性研究,收集北戴河医院2015年07月至2016年08月诊治的符合标准的海蜇蜇伤患者52例(男29例,女23例)作为实验组,本院经体检健康职工28例作为正常对照组。收集海蜇蜇伤患者的临床资料包括性别、年龄、蜇伤部位及面积等,采用ELISA法测定两组血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin,IL-6)、组胺(Histamine,HIS)、5-羟色胺(5-hydroxy tryptamine,5-HT)浓度。纳入标准:符合海蜇蜇伤诊断的患者;因海蜇蜇伤留观或住院患者;年龄14周岁至80周岁;获得患者的知情同意,自愿加入该试验。排除标准:有其他海洋生物接触史;其他原因引起的皮损;并发溺水;合并呼吸系统、心血管、肝脏、肾脏、血液等严重原发病患者;起病至入院超过2d者;入院前使用影响免疫功能的药物(如糖皮质激素);过敏体质;妊娠或哺乳期患者;临床资料不完整或者放弃治疗。根据中国毒理学会中毒与救治专业委员会及河北省医学会急诊医学分会制定的海蜇蜇伤患者病情分级标准,将患者分为轻度、中度、重度蜇伤三组。采用SPSS21.0软件进行统计学分析,比较各组患者的血清TNF-α、IL-6、HIS、5-HT浓度等指标。结果:1海蜇蜇伤组与正常对照组,轻度、中度、重度蜇伤组之间在性别、年龄等方面的差异均不具有统计学意义(P0.05)。2与正常对照组比较,海蜇蜇伤组患者的血清TNF-α、IL-6、HIS、5-HT浓度显著升高,差异具有统计学意义(P0.05);与轻度蜇伤组比较,中度、重度蜇伤组血清TNF-α、IL-6、HIS、5-HT浓度显著升高,差异具有统计学意义(P0.05);与中度蜇伤组比较,重度蜇伤组血清TNF-α、IL-6、HIS、5-HT浓度显著升高,差异具有统计学意义(P0.05);但轻度蜇伤组与正常对照组比较,两者之间血清TNF-α、IL-6、HIS、5-HT浓度差异无统计学意义(P0.05)。3中度蜇伤组与轻度蜇伤组比较,两者血清心肌酶浓度差异无统计学意义(P0.05),与轻度、中度组比较,重度蜇伤组血清心肌酶浓度显著升高,差异具有统计学意义(P0.05)。结论:1血清TNF-α、IL-6、HIS、5-HT可能协同参与了海蜇蜇伤患者病情的发生、发展过程,并且血清中TNF-α、IL-6、HIS、5-HT升高越明显,海蜇蜇伤患者病情越严重。2监测血清TNF-α、IL-6、HIS、5-HT水平对于判断海蜇蜇伤患者病情变化与评估预后可能有一定的临床价值,为海蜇蜇伤的治疗、改善预后提供了重要的理论依据。3海蜇蜇伤能引起心肌酶的改变,心肌酶升高越明显,病情越严重,及早采取保护心肌等治疗措施可能会有助于改善海蜇蜇伤患者的预后。
[Abstract]:Objective: to investigate the pathogenesis of jellyfish sting by detecting the changes of serum cytokines and HIS-5-HT in jellyfish patients, and to evaluate the prognosis and treatment of jellyfish. Methods: a single center prospective study was used to collect 52 jellyfish patients (29 males and 23 females) from July 2015 to August 2016 in Beidaihe Hospital as experimental group. 28 healthy workers were taken as the normal control group. The clinical data of patients with jellyfish sting were collected, including sex, age, site and area of stinging injury. Serum TNF- 伪 necrosis factor- 伪, interleukin-6 Interleukin-IL-6, histamine histamine histamine HISS-5-hydroxytryptamine 5-HT were determined by ELISA method. Inclusion criteria: patients who meet the diagnosis of jellyfish; stay or hospitalization for jellyfish; ages 14 to 80; obtain patient's informed consent and volunteer to participate in the trial. Exclusion criteria: history of exposure to other marine organisms; skin lesions caused by other causes; complicated drowning; patients with severe primary diseases such as respiratory system, cardiovascular, liver, kidney, blood, etc. Use drugs that affect immune function before admission (e.g. glucocorticoid; allergic constitution; pregnant or lactating patients; incomplete clinical data or abandonment of treatment. According to the grading standard of jellyfish patients made by the Committee of poisoning and treatment of the Chinese Toxicology Society and the emergency medicine branch of Hebei Medical Association, the patients were divided into three groups: mild, moderate and severe stings. The serum levels of TNF- 伪 IL-6 and HIS-5-HT were compared by SPSS21.0 software. Results there was no significant difference in sex and age between the jellyfish group and the normal control group, mild, moderate and severe jellyfish group. Compared with the normal control group, the serum TNF- 伪 IL-6HIS5-HT concentration in the jellyfish group was significantly higher than that in the normal control group. Compared with mild and severe stings, the serum TNF- 伪 and IL-6 HIS-5-HT concentrations in moderate and severe stings were significantly higher than those in moderate stings, and the levels of TNF- 伪 and IL-6HIS5-HT in severe stings were significantly higher than those in moderate stings, and the levels of TNF- 伪 and IL-6HIS5-HT in severe stings were significantly higher than those in moderate stings, and the levels of TNF- 伪 and IL-6HIS5-HT in severe stings were significantly higher than those in moderate stings. The difference was statistically significant (P 0.05), but there was no significant difference in serum TNF- 伪 and IL-6, HIS-5-HT between mild sting group and control group. There was no significant difference between moderate sting group and mild sting group, and there was no significant difference in serum TNF- 伪 and HIS-5-HT levels between mild sting group and mild sting group. There was no significant difference in serum myocardial enzyme concentration between the two groups. Compared with mild and moderate group, the serum myocardial enzyme concentration in severe sting group was significantly higher than that in mild and moderate group, and the difference was statistically significant (P 0.05). Conclusion the serum TNF- 伪 IL-6HIS-5-HT may be involved in the occurrence and development of jellyfish disease, and the increase of TNF- 伪 IL-6HIS-5-HT in serum may be more obvious. The more serious the condition of jellyfish is, the more serious it is to monitor the level of serum TNF- 伪 IL-6 and HIS-5-HT in jellyfish patients, which may have some clinical value in judging the changes of the condition and evaluating the prognosis of jellyfish patients, which is the treatment of jellyfish injury. Improving the prognosis of jellyfish provides an important theoretical basis .3 jellyfish can cause changes in myocardial enzymes. The higher the level of myocardial enzyme, the more serious the condition is. Early treatment measures such as myocardial protection may help to improve the prognosis of jellyfish patients with jellyfish.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R646

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