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目的了解环氧化酶(COX)和血小板活化因子(PAF)在全身炎症反应综合征(SIRS)与多器官功能障碍综合征(MODS)患者发病机制中的作用。方法选择28例符合美国胸科医师协会/危重病医学会(ACCP/SCCM)提出的SIRS和MODS诊断标准患者,其中SIRS组13例,MODS组15例,另以与患者年龄、性别相匹配的11名健康体检者作为正常对照组。采用淋巴细胞分离液密度梯度离心法分离外周血单核细胞(PBMCs);用酶联免疫吸附法(ELISA)检测PBMCs中COX2含量与血小板活化因子乙酰水解酶(PAF AH)活性;用逆转录聚合酶链反应(RT PCR)法检测PBMCs中COX2与PAF AH的mRNA表达。结果MODS组患者PBMCs中COX2含量、PAF AH活性及两者的mRNA表达均显著高于正常对照组和SIRS组(P均<0.05),正常对照组与SIRS组间差异无显著性,死亡患者高于存活患者(P均<0.05);3组PBMCs中COX2含量与PAF AH活性间呈正相关关系(r=0.329,P<0.05)。死亡患者的外周血白细胞计数、淋巴细胞计数、氧合指数与存活患者比较差异均无显著性,血糖、血肌酐则明显高于存活患者(P<0.05和P<0.01),CO2总含量(TCO2)、动脉血pH值均明显低于存活患者(P均<0.01)。结论COX2与PAF AH参与了MODS的发病过程,而且可作为判断SIRS与MODS预后的参考指标;血糖、肌酐、TCO2、pH可作为判断病情及预后的其他参考指标。
Objective To investigate the role of cyclooxygenase (COX) and platelet activating factor (PAF) in the pathogenesis of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). Methods Twenty-eight patients with SIRS and MODS were enrolled in this study. Thirteen patients in the SIRS group and 15 patients in the MODS group were selected according to the criteria of ACCP / SCCM. The patients were matched with age and gender Eleven healthy people as normal control group. Peripheral blood mononuclear cells (PBMCs) were isolated by density gradient centrifugation of lymphocytes; COX2 content and PAF-AH activity in PBMCs were detected by enzyme-linked immunosorbent assay (ELISA) The mRNA expression of COX2 and PAF AH in PBMCs was detected by RT-PCR. Results The levels of COX2 and PAF-AH in both PBMCs and MODS were significantly higher in MODS group than those in SIRS group and normal control group (all P <0.05). There was no significant difference between SIRS group and normal control group (P <0.05). There was a positive correlation between COX2 content and PAF AH activity in three groups of PBMCs (r = 0.329, P <0.05). There were no significant differences in peripheral blood leucocyte count, lymphocyte count, oxygenation index and survivors in the patients with death, and blood glucose and serum creatinine were significantly higher than those in survivors (P <0.05 and P <0.01) ), Arterial blood pH values were significantly lower than those of surviving patients (all P <0.01). Conclusions COX2 and PAF AH are involved in the pathogenesis of MODS, and can be used as a reference index to judge the prognosis of SIRS and MODS. Blood glucose, creatinine, TCO2 and pH can be used as other reference indexes to judge the disease and prognosis.