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目的探讨蜂螫伤中毒患者血清粒细胞-单核巨噬细胞集落刺激因子(GM-CSF)、肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)的变化及临床意义。方法将109例蜂螫伤中毒患者分成轻度、中度、重度中毒三组,并根据预后分成死亡组、非死亡组。另选取35名健康人作为正常对照组,采用放射免疫法检测血清GM-CSF和TNF-α水平,酶联免疫吸附法检测血清IL-6、IL-8水平,同时比较各组间的差异。结果蜂螫伤轻度中毒组患者血清GM-CSF、TNF-α、IL-6、IL-8水平仅轻度升高,与正常对照组比较差异无显著性(P＞0．05),中度中毒组和重度中毒患者血清GM-CSF、TNF-α、IL-6、IL-8水平较正常对照组明显升高(P＜0．01),中度中毒组患者血清GM-CSF、TNF-α、IL-6、IL-8水平较轻度中毒组明显升高(P＜0．01),重度中毒组患者血清GM-CSF、TNF-α、IL-6、IL-8水平较中度中毒组明显升高(P＜0．01)。死亡组血清GM-CSF、TNF-α、IL-6、IL-8水平明显高于非死亡组(P＜0．01)。APACHEⅡ评分与血清GM-CSF、TNF-α、IL-6、IL-8水平呈显著正相关(P＜0．05或P＜0．01)。结论血清GM-CSF、TNF-α、IL-6、IL-8R可能协同参与了蜂螫伤中毒患者病情的发生、发展过程。动态观测血清GM-CSF、TNF-α、IL-6、IL-8水平与APACHEⅡ评分对于判断蜂螫伤中毒患者病情轻重与估计预后可能有一定的临床价值。应用细胞因子拮抗剂或抑制剂对防治蜂螫伤中毒患者的发生发展、降低病死率可能有重要的临床意义。
Objective To investigate the effects of GM-CSF, TNF-α, IL-6, IL-8 on patients with bee sting poisoning ) Changes and clinical significance. Methods 109 cases of bee sting poisoning were divided into three groups: mild, moderate and severe poisoning. According to the prognosis, the patients were divided into death group and non-death group. Another 35 healthy volunteers were selected as normal control group. The levels of serum GM-CSF and TNF-α were detected by radioimmunoassay. The levels of serum IL-6 and IL-8 were detected by ELISA, and the differences among groups were also compared. Results Serum levels of GM-CSF, TNF-α, IL-6 and IL-8 in patients with bee sting mild poisoning increased only slightly, but no significant difference compared with normal control group (P> 0.05) The levels of serum GM-CSF, TNF-α, IL-6 and IL-8 in degree poisoning group and severe poisoning group were significantly higher than those in normal control group (P <0.01) The levels of IL-6, IL-8, IL-6 and IL-8 in patients with severe poisoning were significantly higher than those in patients with mild poisoning (P <0.01) Degree poisoning group was significantly higher (P <0.01). The levels of serum GM-CSF, TNF-α, IL-6 and IL-8 in the death group were significantly higher than those in the non-death group (P <0.01). There was a significant positive correlation between APACHEⅡscore and serum levels of GM-CSF, TNF-α, IL-6 and IL-8 (P <0.05 or P <0.01). Conclusion Serum GM-CSF, TNF-α, IL-6 and IL-8R may participate in the pathogenesis and development of bee sting poisoning patients. Dynamic observation of serum levels of GM-CSF, TNF-α, IL-6, IL-8 and APACHEⅡscores may be of clinical value in judging the severity and prognosis of patients with bee sting poisoning. Application of cytokine antagonists or inhibitors in the prevention and treatment of bee sting poisoning in patients with the occurrence and development, reduce mortality may have important clinical significance.