Waage A, Aasen A O
Department of Internal Medicine, University of Trondheim, Norway.
Immunol Rev. 1992 Jun;127:221-30. doi: 10.1111/j.1600-065x.1992.tb01416.x.
So far, there has been a tendency towards a uniform concept of the role and kinetics of TNF and other cytokines in septic shock. However, our comparison of data from different groups of shock patients clearly demonstrates marked differences. On the one hand, the cytokine pattern in experimental septic shock and meningococcal disease has similarities which include early burst releases of TNF and IL-6. On the other hand, intensive care unit patients which includes patients with polytrauma, surgery, burns and other underlying diseases have a completely different pattern of appearance of TNF and IL-6 in the circulation. We have not been able to detect bioactive TNF in the circulation of these patients, whereas others have measured elevated levels of immunoreactive TNF. Bioactive IL-6 can be detected in serum; however, the levels are often fluctuating and there is no common pattern of appearance. These differences probably reflect differences in the release of endotoxin and the immunological status of the patients. TNF inhibitors and soluble TNF receptors probably play an important role. Experimental models for septic shock most commonly use administration of live bacteria or endotoxin to anesthesized healthy animals. This appears to be a good model for meningococcal disease, but not for intensive care unit patients.
到目前为止，对于肿瘤坏死因子（TNF）及其他细胞因子在感染性休克中的作用和动力学，已经有一种趋向统一概念的态势。然而，我们对不同组休克患者数据的比较清楚地表明存在显著差异。一方面，实验性感染性休克和脑膜炎球菌病中的细胞因子模式有相似之处，包括TNF和白细胞介素-6（IL-6）的早期爆发性释放。另一方面，重症监护病房的患者，包括多发伤、手术、烧伤及其他基础疾病患者，其循环中TNF和IL-6的出现模式完全不同。我们在这些患者的循环中未能检测到生物活性TNF，而其他人检测到免疫反应性TNF水平升高。血清中可检测到生物活性IL-6；然而，其水平常常波动，且没有共同的出现模式。这些差异可能反映了内毒素释放和患者免疫状态的不同。TNF抑制剂和可溶性TNF受体可能起重要作用。感染性休克的实验模型最常采用向麻醉的健康动物注射活细菌或内毒素。这似乎是脑膜炎球菌病的良好模型，但不适用于重症监护病房的患者。
