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目的探讨外周血有核细胞CD14mRNA在急性脑血管病(ACVD)引发全身炎症反应综合征(SIRS)及多器官功能障碍综合征(MODS)发病过程中的表达规律以及与病情变化的相关性。方法将153例ACVD患者按病情发展分为单纯ACVD组60例、ACVD引发SIRS组45例及ACVD引发MODS组48例,随机选择无亲缘关系的健康体检者40例作为对照组,采用逆转录-聚合酶链反应(RT-PCR)测定4组对象外周血有核细胞CD14 mRNA的表达。结果 ACVD患者发病第3日CD14 mRNA表达明显升高,CD14mRNA的表达随着病情的逐步加重(对照组→单纯ACVD组→ACVD引发SIRS组→ACVD引发MODS组)呈递升趋势(P<0.01),且4组两两比较也均有统计学意义(P均<0.01)。ACVD引发MODS组中,积分≥9分患者CD14 mRNA的表达明显高于<9分患者(P<0.05),死亡患者外周血有核细胞CD14 mRNA的表达明显高于存活患者(P<0.01)。结论 ACVD这一外源性非感染疾病引发SIRS和MODS的机制可能与机体过度免疫应答有关。
Objective To investigate the expression of CD14 mRNA in peripheral blood mononuclear cells during the pathogenesis of acute cerebrovascular disease (ACVD) -induced systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) and its relationship with disease progression. Methods Fifty-three patients with ACVD were divided into ACVD group (n = 60), ACVD-induced SIRS group (n = 45) and ACVD-induced MODS group (n = 48). Randomly selected 40 unrelated healthy subjects as control group. Polymerase chain reaction (RT-PCR) was used to detect CD14 mRNA expression in peripheral blood mononuclear cells of four groups. Results The expression of CD14 mRNA was significantly increased on the 3rd day after onset of ACVD. The expression of CD14 mRNA showed a trend of increase (P <0.01) as the condition progressed (control group → ACVD group → ACVD-induced SIRS group → ACVD-induced MODS group) There was also a statistically significant difference between 4 groups (P <0.01). The expression of CD14 mRNA in patients with ACVD-induced MODS was significantly higher than that in patients with scores> 9 (P <0.05). The expression of CD14 mRNA in peripheral blood mononuclear cells was significantly higher in survivors than in survivors (P <0.01). Conclusion The mechanism by which ACVD, an exogenous non-infectious disease, induces SIRS and MODS may be related to the excessive immune response in the body.