【摘要】 目的探讨急性脑梗死(ACI)后诱发SIRS及导致多器官功能障碍综合征(MODS)的发病机制。方法收集急性脑梗死患者48例,分为三组,急性单纯脑梗死组(SACI)26例;急性脑梗死致全身炎症反应综合征组(SIRS组)22例;急性脑梗死致多器官功能障碍综合征组(MODS组)13例;应用酶联免疫吸附法(ELISA法)分别测定不同组别患者血清中TNF-α、IL-6值,与对照组(20例同期健康体检者)比较。结果(1)48例ACI致SIRS的发生率为45.83%,ACI致MODS的发生率为27.08%,ACI致SIRS时诱发MODS的发生率为59.09%。(2)ACI致MODS时均已提前发生了SIRS。(3)SACI组、SIRS组及MODS组患者血清TNF-α、IL-6含量均明显高于正常对照组(P<0.01);且SIRS组明显高于SACI组(P<0.01);MODS组明显SIRS组(P<0.01),呈逐渐升高的趋势。(4)MODS不同积分组血清TNF-α、IL-6含量均明显高于SIRS组(P<0.01);且MODS组患者,严重者(积分≥9分)血清TNF-α、IL-6含量明显高于病情较轻者(积分<9分)(P<0.01)。(5)MODS组死亡患者血清TNF-α、IL-6含量明显高于存活者(P<0.01)。结论(1)急性脑梗死(ACI)可以诱发全身炎症反应综合征(SIRS),并且是脑梗死致多器官功能障碍综合征(MODS)的发病基础和前提。(2)ACI首先诱发SIRS,SIRS是致MODS的主要机制,动态监测急性脑梗死患者血清TNF-α、IL-6的变化对急性脑梗死是否导致SIRS及MODS的发生有很高的预警价值。(3)急性脑梗死患者血清TNF-α、IL-6含量可作为判断急性脑梗死致SIRS、急性脑梗死致MODS病变程度、预后及转归的指标,并对及时指导临床早期治疗有着重要意义,对SIRS向MODS过度的早期诊断有非常重要的参考价值。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 48 cases of acute cerebral infarction (ACI) were divided into three groups: 26 cases of simple acute cerebral infarction (SACI) group, 22 cases accompanied with SIRS (SIRS group) and 13 cases accompanied with MODS (MODS group). Enzyme linked immunosorbent assay (ELISA) method was used to measure serum TNF-α and IL-6 levels at different group and compared with 20 healthy persons.Results (1) 45.83% of the 48 ACI cases were accompanied with SIRS of whom 59.09% were accompanied with MODS. 27.08% of the 48 ACI cases were accompanied with MODS. (2) All the MODS patients were SIRS occurred firstly. (3) The serum level of TNF-α and IL-6 in SACI group, SIRS group and MODS group was obviously higher than that in control group (P<0.01), and MODS group’s level was obviously higher than that in SIRS group.(4) The level of TNF-α and IL-6 in MODS group of various score individually was higher than that in SIRS group obviously (P<0.01), what’s more, in patients of ACI accompanied with MODS, severe patients (score≥9) was higher than that in mild patients (score<9)( P<0.01).(5) The serum level of TNF-α and IL-6 in MODS group patient who died was obviously higher than that in survival group(P<0.01).Conclusions (1) Acute cerebral infarction could be accompanied with SIRS, and SIRS could be the pathological basis of MODS after acute cerebral infarction.(2) SIRS is the probable mechanism of acute cerebral infarction with MODS. Monitoring the change of serum level of TNF-α and IL-6 in patients of ACI has a high foretell value to ACI accompanied with SIRS or MODS. (3) The level of the serum TNF-α and IL-6 can become the criteria of disease degree and clinical effective in ACI accompanied with SIRS or ACI accompanied with MODS patients. It was very important for us to diagnose the patients earlier when they transfer from SIRS to MODS.更多还原