【摘要】 目的 探讨重症急性胰腺炎（SAP）患者感染期TNFα的变化特点,并观察其与器官功能变化的关系。方法 测定21例SAP感染期患者的血、尿、胆汁以及正常人血清和胆汁内TNFα活性及肝、肾、肺功能。分为细菌或真菌阳性组（Ⅰ组）和阴性组（Ⅱ组）及正常血清对照组（Ⅲ组）和正常胆汁对照组（Ⅳ组）。结果 胆汁、尿中有细菌或真菌感染的SAP患者（Ⅰ组）,其血清TNFα活性较Ⅱ组显著增高（P<0.01）,但痰液细菌或真菌培养阳性的SAP患者,其血清TNFα较Ⅱ组变化不显著;Ⅰ组胆道感染病人的胆汁内TNFα活性较Ⅱ组显著升高（P<0.01）;Ⅰ组和Ⅱ组的血清、胆汁TNFα活性均显著高于Ⅲ、Ⅳ组（P<0.01）;Ⅰ组的肝、肾、肺功能水平较Ⅱ组显著降低（P<0.05）。结论 全身感染期血清、胆汁TNFα活性存在高、低两个水平,前者可能与器官功能不全有关,后者维持机体的炎症反应。更多还原

【Abstract】 Objective To investigate the changing of TNFa activity and its effects on organ function over infected stage in patients with severe acute pancreatitis. Methods Serum, bile and urine TNFα activity was determined in 21 patients with SAP; Simultaneously, liver, lung and kidney function was observed. Samples from patients were divided into 4 groups. Samples with positive results of bacteria culture of bile, urine, sputum and wounds were in group I , and that with negative results were belong to group II. Serum TNFα activity in 26 volunteers and bile TNFα activity in 11 volunteers are taken as the control groups ( III and IV respectively). Results Compared to group II , Serum TNFα activity in group I with bile and urine infection was increased significantly (P<0.01), but the serum TNFα activity was not increased in patients with sputum infection (P>0.05). Bile TNFα activity was increased significantly in group I compared to group II (P<0.01). Serum and bile TNFα activity in group I , II was higher than group III, IV respectively (P<0.01). And organ function in group I was worse than that in group II (P<0.05). Conclusions There was high and low level of serum and bile TNFα activity during infected stage of SAP. The high level related to MODS, and the low level is a basis of inflammatory response maintaining.更多还原