【摘要】 目的研究血清肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、转化生长因子β1(TGF-β1)、E-选择素和L-选择素在肾综合征出血热(HFRS)发病机制中的作用。方法41例HFRS患者(轻症组22例,重症组19例)接受了研究,按病期采血,分别用放射免疫法和ELISA法检测血清TNF-α、IL-1β、TGF-β1、E-选择素和L-选择素,并同期作肝、肾功能和血常规检查。结果从发热期至多尿期,血清IL-1β、TNF-α、E-选择素、L-选择素均显著升高,与ALT、BUN的变化趋势相一致;与此相反,血清TGF-β1含量、TGF-β1/IL-1β和TGF-β1/TNF-α比值在病程前三期均见降低,与Plt的变化趋势相似。结论HFRS急性期血清IL-1β、E-选择素、L-选择素升高和TGF-β1水平下降是造成失控性全身炎症反应和肝、肾功能损害的重要因素,在HFRS发病机制中起重要作用;合理的对症治疗和适量使用免疫调节剂可望改善本病的预后。更多还原

【Abstract】 Objective To evaluate the role of serum levels of soluble tumour necrosis factor-α（TNF-α）,interleuleukin-1β（IL-1β）,transforming growth factor β₁（TGF-β₁）,E-selectin and L-selectin in the pathogenesis of hemorrhagic fever with renal syndrome（HFRS）.Methods Blood samples from 41 HFRS patients（22 of moderate type,19 of severe type） were collected for detecting TNF-α and IL-1β,and ELISA for E-selectin,L-selectin and TGF-β₁ by radioimmunoassay.Meanwhile,serum alanine aminotransferase（ALT）,blood urea nitrogen（BUN） and platelet count were examined.ResultsDuring the first three stages of HFRS,serum levels of IL-1β,TNF-α,L-selectin and E-selectin were significantly increased,the curves of them were sinilar to those of ALT and BUN.On the contrary,serum TGF-β₁ level,TGF-β₁/IL-1β ratio,TGF-β₁/TNF-α ratio and blood platelet count were significantly decreased in a parallel manner,so did the changes of platelet.Conclusions The increased serum levels of soluble TNF-α,IL-1β,E-selectin and L-selectin associated with a decreased TGF-β₁ level might be an important cause leading to uncontrolled systemic inflammatory response and liver-kidney damage,and thus involved in the pathogenesis of HFRS.The combination of reasonably symptomatic therapy with immunomodulator would improve the prognosis of HFRS.更多还原