Endo S, Inada K, Yamada Y, Kasai T, Takakuwa T, Nakae H, Kamei Y, Shimamura T, Suzuki T, Taniguchi S, Yoshida M
Critical Care and Emergency Center, Iwate Medical University, Morioka 020, Japan.
J Med. 1996;27(1-2):57-71.
The present study was conducted to determine whether a plasma interleukin-1 receptor antagonist (IL-1ra) would reflect the severity of burn injury and to examine the relation between IL-1ra and the cytokines. We studied 24 burn patients in whom the total burn surface area (TBSA) accounted for at least 20% of the body surface, and in whom serial blood samples could be obtained beginning immediately after the burn injury. Plasma levels of IL-1ra were determined by enzyme-linked immunosorbent assay (ELISA). Plasma levels of tumor necrosis factor-alpha (TNF-alpha), IL-6, and IL-8 were also determined by ELISA. Endotoxin was measured by an endotoxin-specific synthetic substrate method. There was a significant correlation between the plasma levels of IL-1ra and TBSA during the first week following burn injury. The IL-1ra level was the highest immediately after the burn injury. The level decreased markedly thereafter, and again rose when infection occurred. The IL-1ra level was extraordinarily elevated in patients who developed concomitant sepsis, septic shock or the septic multiple organ dysfunction syndrome. The IL-1ra level on admission and the maximum IL-1ra level during the observation period were significantly higher in the patients who eventually died than in the survivors. There was a significant correlation between the level of IL-1ra and that of TNF-alpha, IL-6 or IL-8 during the observation period. No correlation was found between IL-1ra and endotoxin. The plasma IL-1ra level was closely correlated with the severity of inflammation and the clinical status of the burn patients, regardless of the infection. Results suggest that IL-1ra can serve as an index of the systemic inflammatory response syndrome (SIRS).
本研究旨在确定血浆白细胞介素-1受体拮抗剂（IL-1ra）是否能反映烧伤的严重程度，并探讨IL-1ra与细胞因子之间的关系。我们研究了24例烧伤患者，这些患者的烧伤总面积（TBSA）至少占体表面积的20%，且在烧伤后可立即开始连续采集血样。采用酶联免疫吸附测定（ELISA）法测定血浆IL-1ra水平。还采用ELISA法测定血浆肿瘤坏死因子-α（TNF-α）、IL-6和IL-8水平。采用内毒素特异性合成底物法测定内毒素。烧伤后第一周血浆IL-1ra水平与TBSA之间存在显著相关性。IL-1ra水平在烧伤后立即最高。此后该水平显著下降，在发生感染时再次升高。发生脓毒症、脓毒性休克或脓毒性多器官功能障碍综合征的患者IL-1ra水平异常升高。最终死亡患者入院时的IL-1ra水平和观察期内的最高IL-1ra水平显著高于存活患者。观察期内IL-1ra水平与TNF-α、IL-6或IL-8水平之间存在显著相关性。未发现IL-1ra与内毒素之间存在相关性。无论是否感染，血浆IL-1ra水平与烧伤患者的炎症严重程度和临床状况密切相关。结果表明，IL-1ra可作为全身炎症反应综合征（SIRS）的一个指标。
