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目的探讨肿瘤坏死因子α(TNFα)与内皮素(ET)在蜂螫伤中毒患者中的变化及临床意义。方法将97例蜂螫伤中毒患者分成轻度、中度、重度中毒3组,并根据预后分成死亡组、存活组。另选取35例健康人作为正常对照组,各组均采用放射免疫法检测血清TNFα与血浆ET水平,同时进行对比分析。结果蜂螫伤中毒患者轻度中毒组血清TNFα(1．36±0．37)μg／L与血浆ET (55．20±12．60)ng／L的含量仅轻度升高,与正常对照组[(1．09±0．25)μg／L、(50．90±8．80)ng／L]比较差异无统计学意义(P>0．05);中度、重度组患者血清TNFα(2．82±0．79)μg／L、(4．02±0．93)μg／L与血浆ET水平(139．30±58．80)ng／L、(210．50±86．30)ng／L较正常对照组明显升高(P值均<0．01),中度组患者血清TNFα与血浆ET水平较轻度组为高(P<0．01),重度组患者又较中度组高(P<0．01)。死亡组血清TNFα(4．53±0．89)μg／L与血浆ET(267．50±98．70)ng／L水平高于存活组(2．40±0．82)μg／L、(107．60±57．90)ng／L(P值均<0．01)。蜂螫伤中毒患者血清TNFα与血浆ET水平呈正相关(r=0．62,P<0．01)。结论TNFα与ET可能协同参与了蜂螫伤中毒患者的发病过程。血清TNFα与血浆ET升高越明显,蜂螫伤中毒患者病情越重,病死率就越高。血清TNFα与血浆ET的检测可作为判断病情轻重和预后的一个重要临床指标。应用TNFα与ET拮抗剂或抑制剂对防治蜂螫伤中毒的发生发展、改善预后可能有重要的临床意义。
Objective To investigate the changes and clinical significance of tumor necrosis factor α (TNFα) and endothelin (ET) in bee sting poisoning patients. Methods 97 cases of bee sting poisoning were divided into mild, moderate and severe poisoning groups, and divided into death group and survival group according to the prognosis. Another 35 healthy individuals were selected as the normal control group. The levels of serum TNFα and plasma ET were measured by radioimmunoassay in each group. At the same time, comparative analysis was conducted. Results The levels of serum TNFα (1.36 ± 0.37) μg / L and plasma ET (55.20 ± 12.60) ng / L were slightly increased in patients with bee poisoning. Compared with the normal controls (1.09 ± 0.25) μg / L, (50.90 ± 8.80) ng / L], there was no significant difference between the two groups (P> 0.05) (2.82 ± 0.79) μg / L, (4.02 ± 0.93) μg / L and plasma ET level (139.30 ± 58.80) ng / L, (210.50 ± 86.30 ) ng / L was significantly higher than that of the normal control group (P <0.01). The levels of serum TNFα and plasma ET in the moderate group were higher than those in the mild group (P <0.01) Moderate high (P <0.01). The levels of serum TNFα (4.53 ± 0.89) μg / L and plasma ET (267.50 ± 98.70) ng / L in the death group were significantly higher than those in the surviving group (2.40 ± 0.82 μg / L, 107.60 ± 57.90) ng / L (all P <0.01). Serum TNFα levels in patients with bee sting poisoning were positively correlated with plasma ET levels (r = 0.62, P <0.01). Conclusion TNFα and ET may be involved in the pathogenesis of bee sting poisoning patients. Serum TNFα and plasma ET increased the more obvious, bee stings poisoning patients become more serious, the higher the case fatality rate. Serum TNFα and plasma ET detection can be used as a judgment of severity and prognosis of an important clinical indicator. The application of TNFα and ET antagonists or inhibitors may play an important clinical role in prevention and treatment of bee sting poisoning and improving prognosis.