本文關(guān)鍵詞： 全身炎癥反應(yīng)綜合征 多器官功能障礙綜合征 中性粒細(xì)胞 彈性蛋白酶 髓過氧化物酶活性 白介素8 腫瘤壞死因子α 流式細(xì)胞儀 急性生理與慢性健康狀況評(píng)估Ⅲ　出處：《第二軍醫(yī)大學(xué)》2006年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究多器官功能障礙綜合征患者病情發(fā)展不同階段(SIRS期和MODS期)中性粒細(xì)胞功能的變化,探討中性粒細(xì)胞在MODS病情演進(jìn)中的作用。 材料與方法:10例我院加強(qiáng)醫(yī)療病房(ICU)收治的具有明顯SIRS和MODS分期的MODS患者為研究對(duì)象。其中男性5例,女性5例,平均年齡59.8歲,包括上消化道穿孔術(shù)后3例,多發(fā)傷術(shù)后2例,腸梗阻術(shù)后3例,化膿性膽管炎術(shù)后2例。分別在SIRS期和MODS期,取外周靜脈血3ml,肝素抗凝,采用流式細(xì)胞儀檢測其外周血中性粒細(xì)胞功能:①中性粒細(xì)胞在化學(xué)趨化三肽fMLP刺激下趨化通過3μm細(xì)胞池濾膜的功能;②中性粒細(xì)胞吞噬經(jīng)調(diào)理的大腸埃希菌的功能;③中性粒細(xì)胞在大腸埃希菌刺激下發(fā)生氧化呼吸爆發(fā)的功能。分析中性粒細(xì)胞功能變化與MODS患者病情演進(jìn)的關(guān)系。采用酶聯(lián)免疫吸附法(ELISA法)動(dòng)態(tài)檢測患者不同時(shí)期血清TNF-α、IL-8水平的變化;采用比色法分別檢測疾病不同時(shí)期患者血漿中性粒細(xì)胞彈性蛋白酶活性;分別于SIRS期和MODS期抽取外周靜脈血2ml,應(yīng)用ADVIA 120全自動(dòng)血細(xì)胞分析儀全血法測定中性粒細(xì)胞髓過氧化物酶活性指數(shù);采用硝酸還原酶法測定不同時(shí)期患者血漿NO濃度。8例健康志愿者平均年齡27.2±4.3歲,其中男性6例,女性2例,均無慢性炎癥病史,在抽血前1月無急性炎癥發(fā)作病史。抽取外周靜脈血15ml,按照上述方法測定各指標(biāo)作為正常值參照。運(yùn)用軟件動(dòng)態(tài)分析隨著病情進(jìn)展患者血漿各細(xì)胞因子水平變化情況并分析血漿NO水平變化與中性粒細(xì)胞功能變化的相關(guān)性。 結(jié)果:①PMN的功能變化:與健康對(duì)照組相比,SIRS期患者外周血中性粒細(xì)胞的趨化、吞噬、氧化呼吸爆發(fā)功能均明顯增強(qiáng)(P0.01),而MODS期患者外周血中性粒細(xì)胞趨化、吞噬功能減弱(P0.01),但呼吸爆發(fā)功能持續(xù)增強(qiáng),且高于SIRS期(P0.01)。②血清中性粒細(xì)胞彈性蛋白酶活性隨著病情的發(fā)展逐漸增強(qiáng),即MODS期SIRS期健康對(duì)照組。SIRS組、MODS組與健康對(duì)照組比,差異顯著(P0.01)。MODS組與SIRS組比,差異顯著(P0.01)。③所有健康志愿者中性粒細(xì)胞髓過氧化物酶指數(shù)(MPXI)都在±10范圍內(nèi),SIRS期患者的MPXI在+20～+30范圍內(nèi),MODS期患者的MPXI均大于+30,說明隨著病情的發(fā)展,中性粒細(xì)胞髓
[Abstract]:Aim: to study the changes of neutrophil function in patients with multiple organ dysfunction syndrome (MDS) in different stages of disease development, and to explore the role of neutrophils in the progression of MODS. Materials and methods Ten cases of MODS patients with obvious SIRS and MODS staging were studied, including 5 males and 5 females, with an average age of 59.8 years, including 3 patients with upper gastrointestinal perforation. There were 2 cases of multiple injury, 3 cases of intestinal obstruction and 2 cases of suppurative cholangitis after operation. Flow cytometry was used to detect the function of neutrophil function: 1 in peripheral blood stimulated by chemotactic tripeptide fMLP. The function of neutrophilic granulocyte phagocytosis of regulated Escherichia coli through 3 渭 m cell filter membrane was determined by flow cytometry. The function of neutrophils in oxidative respiratory burst induced by Escherichia coli was analyzed. The relationship between the changes of neutrophil function and the progression of MODS was analyzed. The dynamic detection of neutrophils in patients with MODS was performed by enzyme-linked immunosorbent assay (Elisa). The changes of serum TNF- 偽 and IL-8 levels during the period; The plasma neutrophil elastase activity was detected by colorimetry in patients with different stages of disease. Peripheral venous blood was collected from SIRS phase and MODS phase, and the myeloperoxidase activity index of neutrophils was measured by ADVIA 120 automatic blood analyzer. The mean age of plasma no concentration was 27.2 鹵4.3 years old in 8 healthy volunteers, including 6 males and 2 females, all of whom had no history of chronic inflammation. There was no history of acute inflammatory attack on January before blood sampling. 15 ml of peripheral venous blood was extracted and measured as a normal reference according to the above method. Dynamic analysis of plasma cytokines levels was used to analyze the changes of plasma cytokines with the progression of the disease. The relationship between plasma no level and neutrophil function was analyzed. Results compared with the control group, the neutrophil chemotaxis, phagocytosis and oxidative respiratory burst function of neutrophils in patients with Sirs were significantly increased, while in patients with MODS, the neutrophil chemotaxis in peripheral blood was observed. The phagocytic function was weakened (P 0.01), but the respiratory burst function was continuously enhanced, and the activity of neutrophil elastase in serum was higher than that in the SIRS phase. The activity of neutrophil elastase increased gradually with the development of the disease, that is, the ratio of mods group to the healthy control group in the SIRS phase of MODS phase. Sirs group was higher than that in the healthy control group. Compared with SIRS group, there was a significant difference between P0.01mods group and SIRS group. All the healthy volunteers showed that the MPXI of Sirs patients in the range of 鹵10 was more than 30 in the range of 20 ~ 30, indicating that the MPXI of patients with mods was more than 30 in the range of 鹵10, indicating that the MPXI of patients with mods was more than 30 in the range of 20 ~ 30, which indicated that the MPXI of patients with mods was more than 30 in the range of 鹵10. Neutrophil pulp
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：R365

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 邢宇坤,張偉;中性粒細(xì)胞呼吸爆發(fā)的產(chǎn)生機(jī)制及其炎癥效應(yīng)[J];基礎(chǔ)醫(yī)學(xué)與臨床;2004年01期

2 許永春,李兆申,屠振興,施新崗,龔燕芳,滿曉華,金晶;重癥急性胰腺炎早期肺組織內(nèi)細(xì)胞因子誘導(dǎo)的中性粒細(xì)胞趨化因子基因的表達(dá)[J];解放軍醫(yī)學(xué)雜志;2004年08期

3 揭志軍,羅勇,徐衛(wèi)國,林建海,宋志芳,蔡映云;急性肺損傷患者血清中中性粒細(xì)胞彈性蛋白酶活性的變化[J];中華急診醫(yī)學(xué)雜志;2005年06期

4 林玲,方力爭,王琦;重癥急性胰腺炎外周血中性粒細(xì)胞凋亡與多器官功能障礙綜合征[J];中國實(shí)用外科雜志;2003年09期

5 虎曉岷,尹文,宋祖軍,劉健,張金山;危重病患者多器官功能障礙綜合征細(xì)胞因子變化的意義[J];中國急救醫(yī)學(xué);2001年12期

，

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