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甲基强的松龙对重症蜂蜇伤患者的治疗分析

张祥文,吴孟君,李丽华,夏敬彪   

  1. 三峡大学第一临床医学院肾病科，湖北省宜昌市中心人民医院肾病科
  • 收稿日期:2011-07-19 修回日期:2011-11-09 出版日期:2012-05-15 发布日期:2012-05-15
  • 通讯作者: 张祥文

  • Received:2011-07-19 Revised:2011-11-09 Published:2012-05-15 Online:2012-05-15
  • Contact: Xiangwen Zhang

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摘要： 【摘要】 目的 探讨重症蜂蜇伤患者血清中肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、白细胞介素8（IL-8）的水平及甲基强的松龙冲击对其的影响。方法 将蜂蜇伤患者随机分为治疗组与对照组，2组均给予器官功能支持为主的综合治疗；治疗组前三天予以甲基强的松龙0.5g/d静脉滴注。分别于0h、2h观察2组患者的细胞因子（TNF-α，IL-6和IL-8）水平、2组患者入院0h、72h器官功能损害程度、并比较2组患者的死亡率。结果 0h时，治疗组、对照组TNF-α、IL-6和IL-8水平分别为3.21±0.84、113.25±35.61、162.49±79.33；3.17±0.79、109.83±32.58、157.71±73.65，二者比较无统计学差异（P＞0.05）；但在2h时TNF-α、IL-6、IL-8水平分别为8.11±2.34、37.95±11.68、53.99±25.86；15.67±5.21、314.76±86.40、452.07±211.09，存在统计学差异（P﹤0.05）；72h时，甲基强的松龙冲击治疗组患者器官功能损害程度明显低于对照组，存在显著的统计学差异（P﹤0.01或﹤0.05）；甲基强的松龙冲击治疗组患者治愈率明显高于对照组，存在统计学差异（P﹤0.05）. 结论 炎性细胞因子在引起蜂蜇伤患者多器官功能损害中起了重要作用, 甲基强的松龙冲击治疗可以明显减轻蜂蜇伤引起的这种损伤。甲基强的松龙冲击治疗可能降低蜂蜇伤急性期病死率,改善远期预后。

关键词: 蜂蜇伤, 多器官功能损害, 甲基强的松龙, 细胞因子, 抗炎治疗

Abstract: [Abstract] Objective: To investigate the expression level of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) in the serum of patients following wasp sting, and the effects after methylprednisolone plus treatment. Method: patients following wasp sting were randomly divided into treatment and control groups, the paitents of two groups were given organ support combined therapy; patients in treatment group were treated by intravenously injection of methylprednisolone 0.5g /d in the first three days. The expression level of TNF-α, IL-1, IL-6, IL-8 in the tow group of patients were detected by ELISA at 0h and 2h respectively, organ damage were evaluated at 0h, 72h after admitted to hospital respectively, and the death rate of the two groups were compared. Result: The expression level of TNF-α, IL-6 and IL-8 at 0h in the patients of treatment group and control group were 3.21 ± 0.84, 113.25 ± 35.61, 162.49 ± 79.33 and 3.17 ± 0.79,109.83 ± 32.58,157.71 ± 73.65 respectively, showed no statistically significant difference (P> 0.05); at 2h , the expression level of TNF-α, IL-6, IL-8 in tow groups were 8.11 ± 2.34,37.95 ± 11.68,53.99 ± 25.86 and 15.67 ± 5.21,314.76 ± 86.40,452.07 ± 211.09 respectively, there was a significant statistical difference (P <0.05) when compare to the control group. At 72 hour, the organ dysfunction of patients in methylprednisolone plus treatment group is significantly lower compare to the patients in control group (P <0.05 or P <0.01). The cure rate in methylprednisolone treatment group was significantly higher compare to control group (P <0.05). Conclusion: Inflammatory cytokines play an important role in the multiple organ dysfunction caused by wasp stings, methylprednisolone pulse therapy can significantly reduce this damage caused by wasp sting. Methylprednisolone pulse therapy may reduce the mortality of acute wasp sting, and to improve the long-term prognosis.

Key words: Wasp sting, Multiple organ dysfunction, Methylprednisolone, Cytokine, Anti-inflammatory therapy