Exley A R, Leese T, Holliday M P, Swann R A, Cohen J
Department of Bacteriology, Hammersmith Hospital, London.
Gut. 1992 Aug;33(8):1126-8. doi: 10.1136/gut.33.8.1126.
Endotoxaemia and circulating tumour necrosis factor are important prognostic factors in severe sepsis and are implicated in the pathogenesis of septic shock. Because clinical and pathological features in acute pancreatitis are similar to septic shock this study sought to determine whether endotoxin and tumour necrosis factor were prognostic factors in 38 patients with prognostically severe acute pancreatitis. Endotoxaemia, present in 19/37 (51%) patients on day 1, was more common in nonsurvivors than survivors (10/11, 91% v 9/26, 35%, p = 0.003). Day 1 serum endotoxin concentrations were higher in patients with a severe outcome (median (interquartile range) 314 (173-563) pg/ml v 0 (0-185) pg/ml, p<0.01) and in non-survivors (266 (173-586) pg/ml v 0 (0-165) pg/ml, p<0.01). Serum tumour necrosis factor was detectable in 47 of 109 samples (43%) from 38 patients (median 35 pg/ml, range 5-943 pg/ml). Day 1 serum tumour necrosis factor correlated with a worse prognostic score and a severe outcome in all patients (n = 38, r = 0.36, p = 0.027; r = 0.33, p<0.05) and with mortality in patients with gall stones (n = 23, r = 0.50, p = 0.02). Our data suggest that endotoxin and tumour necrosis factor could be prognostic factors in severe acute pancreatitis.
内毒素血症和循环肿瘤坏死因子是严重脓毒症的重要预后因素，并与感染性休克的发病机制有关。由于急性胰腺炎的临床和病理特征与感染性休克相似，本研究旨在确定内毒素和肿瘤坏死因子是否为38例预后严重的急性胰腺炎患者的预后因素。19/37（51%）的患者在第1天出现内毒素血症，非存活者比存活者更常见（10/11，91%对9/26，35%，p = 0.003）。严重预后患者第1天的血清内毒素浓度更高（中位数（四分位间距）314（173 - 563）pg/ml对0（0 - 185）pg/ml，p<0.01），非存活者也是如此（266（173 - 586）pg/ml对0（0 - 165）pg/ml，p<0.01）。在38例患者的109份样本中，47份（43%）可检测到血清肿瘤坏死因子（中位数35 pg/ml，范围5 - 943 pg/ml）。第1天的血清肿瘤坏死因子与所有患者较差的预后评分和严重结局相关（n = 38，r = 0.36，p = 0.027；r = 0.33，p<0.05），并与胆结石患者的死亡率相关（n = 23，r = 0.50，p = 0.02）。我们的数据表明，内毒素和肿瘤坏死因子可能是严重急性胰腺炎的预后因素。
