【摘要】 目的　以目前外科领域及危重病领域公认的全身炎症反应综合征 (SIRS)、多器官功能障碍综合征(MODS)的统一诊断标准 ,探讨急性脑梗死 (ACI)诱发 SIRS致 MODS的发病机制 ,以及血清肿瘤坏死因子 (TNF- α)、细胞间粘附分子 (ICAM- 1)含量变化在 ACI诱发 SIRS发生发展并向 MODS转化中的临床意义。方法　 ACI 6 8例 ,分为 3组 ,其中急性单纯性脑梗死组 (SACI组 ) 36例 ,ACI致 SIRS组 (SIRS组 ) 32例 ,ACI致 MODS组 (MODS组 ) 2 4例。正常对照组 2 8例。血清 TNF-α、ICAM- 1测定应用酶联免疫吸附法 (EL ISA法 )。结果　 (1)本组 ACI时致 SIRS的发生率为 4 7.0 6 %。ACI时致 MODS的发生率为 35 .2 9%。ACI致 SIRS时 MODS的发生率为 75 .0 0 %。ACI致 MODS时 10 0 %发生 SIRS。 (2 )血清 TNF- α、ICAM- 1的含量在 SACI组、SIRS组、MODS组与正常对照组比较 ,差异显著 (P<0 .0 1)。血清 TNF- α、ICAM- 1的含量为 MODS组 >SIRS组 >ACI组 >正常对照组。SIRS组、MODS组与 SACI组比较 ,差异显著 (P<0 .0 1)。 MODS组与 SIRS组比较 ,差异显著 (P<0 .0 1)。急性脑梗死致 MODS严重者 (积分≥ 9分 )血清 TNF-α、ICAM- 1含量均高于病情较轻者 (积分 <9分 ,P<0 .0 1) ;ACI致 MODS死亡组血清 TNF-α、ICAM- 1含量均高于存更多还原

【Abstract】 Objective To explore the mechanism of the acute cerebral infarction leading to Systemic Inflammatory Response Syndrome(SIRS) which causes Multiple Organ Dysfunction Syndrome(MODS). Methods 68 cases of acute cerebral infarction(ACI) were divided into three groups. 36 cases were acute simple cerebral infarction(SACI group),32 cases were acute cerebral infartion companied with SIRS(SIRS group),24 cases were acute cerebral infarction companied with MODS(MODS group). 28 cases were normal control group. ELISA method was used to measure serum TNF-α and ICAM-1 levels. Results (1)The morbidity of the acute cerebral infarction with SIRS was 47.06%. The morbidity of the acute cerebral infarction with MODS was 35.29%. The morbidity of the MODS was 75.00% when the acute cerebral infarction with SIRS. The morbidity of SIRS was 100% when acute cerebral infarction progressed to MODS. (2)The serum TNF-α and ICAM-1 levels in patients with SACI,SIRS and MODS was significantly different to those in patients of the normal control group(P<(0.01)). The serum TNF-α and ICAM-1 levels in patients was MODS group > SIRS group > ACI group> normal control group. The serum TNF-α and ICAM-1 levels in patients with SIRS and MODS was significantly different to those in the patients of SACI group(P<(0.01)). The serum TNF-α and ICAM-1 levels in patients with MODS group was significantly different to those in the patients of SIRS group(P<(0.01)). The serum TNF-α and ICAM-1 levels in severe patients were higher than in light ones(P<(0.01)). The serum TNF-α and ICAM-1 levels in patients with MODS death group were higher than those of survival group. (P<(0.01)). Conclusion (1)Acute cerebral infarction might progress SIRS firstly and then progress MODS. (2)The serum TNF-α and ICAM-1 content changing were the possible mechanism in acute cerebral infarction patients with SIRS caused MODS. The level of the serum TNF-α and ICAM-1 content can become the criteria of disease of severe degree and the prognosis in the ACI with SIRS/MODS.更多还原