本文選題：海蜇蜇傷 + 細胞因子�。� 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過檢測海蜇蜇傷患者血清細胞因子及HIS、5-HT的變化,探討海蜇蜇傷的發(fā)病機制,進而評估預(yù)后及指導治療。方法:本研究采用單中心、前瞻性研究,收集北戴河醫(yī)院2015年07月至2016年08月診治的符合標準的海蜇蜇傷患者52例(男29例,女23例)作為實驗組,本院經(jīng)體檢健康職工28例作為正常對照組。收集海蜇蜇傷患者的臨床資料包括性別、年齡、蜇傷部位及面積等,采用ELISA法測定兩組血清腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)、白細胞介素-6(Interleukin,IL-6)、組胺(Histamine,HIS)、5-羥色胺(5-hydroxy tryptamine,5-HT)濃度。納入標準:符合海蜇蜇傷診斷的患者;因海蜇蜇傷留觀或住院患者;年齡14周歲至80周歲;獲得患者的知情同意,自愿加入該試驗。排除標準:有其他海洋生物接觸史;其他原因引起的皮損;并發(fā)溺水;合并呼吸系統(tǒng)、心血管、肝臟、腎臟、血液等嚴重原發(fā)病患者;起病至入院超過2d者;入院前使用影響免疫功能的藥物(如糖皮質(zhì)激素);過敏體質(zhì);妊娠或哺乳期患者;臨床資料不完整或者放棄治療。根據(jù)中國毒理學會中毒與救治專業(yè)委員會及河北省醫(yī)學會急診醫(yī)學分會制定的海蜇蜇傷患者病情分級標準,將患者分為輕度、中度、重度蜇傷三組。采用SPSS21.0軟件進行統(tǒng)計學分析,比較各組患者的血清TNF-α、IL-6、HIS、5-HT濃度等指標。結(jié)果:1海蜇蜇傷組與正常對照組,輕度、中度、重度蜇傷組之間在性別、年齡等方面的差異均不具有統(tǒng)計學意義(P0.05)。2與正常對照組比較,海蜇蜇傷組患者的血清TNF-α、IL-6、HIS、5-HT濃度顯著升高,差異具有統(tǒng)計學意義(P0.05);與輕度蜇傷組比較,中度、重度蜇傷組血清TNF-α、IL-6、HIS、5-HT濃度顯著升高,差異具有統(tǒng)計學意義(P0.05);與中度蜇傷組比較,重度蜇傷組血清TNF-α、IL-6、HIS、5-HT濃度顯著升高,差異具有統(tǒng)計學意義(P0.05);但輕度蜇傷組與正常對照組比較,兩者之間血清TNF-α、IL-6、HIS、5-HT濃度差異無統(tǒng)計學意義(P0.05)。3中度蜇傷組與輕度蜇傷組比較,兩者血清心肌酶濃度差異無統(tǒng)計學意義(P0.05),與輕度、中度組比較,重度蜇傷組血清心肌酶濃度顯著升高,差異具有統(tǒng)計學意義(P0.05)。結(jié)論:1血清TNF-α、IL-6、HIS、5-HT可能協(xié)同參與了海蜇蜇傷患者病情的發(fā)生、發(fā)展過程,并且血清中TNF-α、IL-6、HIS、5-HT升高越明顯,海蜇蜇傷患者病情越嚴重。2監(jiān)測血清TNF-α、IL-6、HIS、5-HT水平對于判斷海蜇蜇傷患者病情變化與評估預(yù)后可能有一定的臨床價值,為海蜇蜇傷的治療、改善預(yù)后提供了重要的理論依據(jù)。3海蜇蜇傷能引起心肌酶的改變,心肌酶升高越明顯,病情越嚴重,及早采取保護心肌等治療措施可能會有助于改善海蜇蜇傷患者的預(yù)后。
[Abstract]:Objective: to investigate the pathogenesis of jellyfish sting by detecting the changes of serum cytokines and HIS-5-HT in jellyfish patients, and to evaluate the prognosis and treatment of jellyfish. Methods: a single center prospective study was used to collect 52 jellyfish patients (29 males and 23 females) from July 2015 to August 2016 in Beidaihe Hospital as experimental group. 28 healthy workers were taken as the normal control group. The clinical data of patients with jellyfish sting were collected, including sex, age, site and area of stinging injury. Serum TNF- 偽 necrosis factor- 偽, interleukin-6 Interleukin-IL-6, histamine histamine histamine HISS-5-hydroxytryptamine 5-HT were determined by ELISA method. Inclusion criteria: patients who meet the diagnosis of jellyfish; stay or hospitalization for jellyfish; ages 14 to 80; obtain patient's informed consent and volunteer to participate in the trial. Exclusion criteria: history of exposure to other marine organisms; skin lesions caused by other causes; complicated drowning; patients with severe primary diseases such as respiratory system, cardiovascular, liver, kidney, blood, etc. Use drugs that affect immune function before admission (e.g. glucocorticoid; allergic constitution; pregnant or lactating patients; incomplete clinical data or abandonment of treatment. According to the grading standard of jellyfish patients made by the Committee of poisoning and treatment of the Chinese Toxicology Society and the emergency medicine branch of Hebei Medical Association, the patients were divided into three groups: mild, moderate and severe stings. The serum levels of TNF- 偽 IL-6 and HIS-5-HT were compared by SPSS21.0 software. Results there was no significant difference in sex and age between the jellyfish group and the normal control group, mild, moderate and severe jellyfish group. Compared with the normal control group, the serum TNF- 偽 IL-6HIS5-HT concentration in the jellyfish group was significantly higher than that in the normal control group. Compared with mild and severe stings, the serum TNF- 偽 and IL-6 HIS-5-HT concentrations in moderate and severe stings were significantly higher than those in moderate stings, and the levels of TNF- 偽 and IL-6HIS5-HT in severe stings were significantly higher than those in moderate stings, and the levels of TNF- 偽 and IL-6HIS5-HT in severe stings were significantly higher than those in moderate stings, and the levels of TNF- 偽 and IL-6HIS5-HT in severe stings were significantly higher than those in moderate stings. The difference was statistically significant (P 0.05), but there was no significant difference in serum TNF- 偽 and IL-6, HIS-5-HT between mild sting group and control group. There was no significant difference between moderate sting group and mild sting group, and there was no significant difference in serum TNF- 偽 and HIS-5-HT levels between mild sting group and mild sting group. There was no significant difference in serum myocardial enzyme concentration between the two groups. Compared with mild and moderate group, the serum myocardial enzyme concentration in severe sting group was significantly higher than that in mild and moderate group, and the difference was statistically significant (P 0.05). Conclusion the serum TNF- 偽 IL-6HIS-5-HT may be involved in the occurrence and development of jellyfish disease, and the increase of TNF- 偽 IL-6HIS-5-HT in serum may be more obvious. The more serious the condition of jellyfish is, the more serious it is to monitor the level of serum TNF- 偽 IL-6 and HIS-5-HT in jellyfish patients, which may have some clinical value in judging the changes of the condition and evaluating the prognosis of jellyfish patients, which is the treatment of jellyfish injury. Improving the prognosis of jellyfish provides an important theoretical basis .3 jellyfish can cause changes in myocardial enzymes. The higher the level of myocardial enzyme, the more serious the condition is. Early treatment measures such as myocardial protection may help to improve the prognosis of jellyfish patients with jellyfish.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R646

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