Adamik B, Zimecki M, Właszczyk A, Kübler A
Department of Anesthesiology and Intensive Therapy, University Medical School, Wrocław, Poland.
Arch Immunol Ther Exp (Warsz). 1997;45(2-3):169-75.
The aim of this study was to monitor plasma interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-alpha), levels in patients with sepsis, septic shock and multiple organ dysfunction syndrome admitted to the intensive care unit. The patients obtained adequate supportive therapy. Plasma samples were taken upon admission, then on days 1, 2, and 5 following admission. IL-6 and TNF-alpha levels were determined using bioassays (7TD1 and WEHI-164.13 indicator cell lines, respectively). The results showed that the kinetics of the cytokine release in septic patients differed significantly between survivors and nonsurvivors. In survivors IL-6 concentrations were initially high, fell down rapidly on day 1 after admission, and persisted very low throughout the monitoring time. In contrast, relatively low IL-6 levels in the nonsurvivors, registered upon admission, rose significantly with peak values on day 3 of observation, declining thereafter. TNF-alpha levels were initially higher in survivors than in nonsurvivors, declined on day 1 following admission, and on day 5 they were higher than the initial values. In nonsurvivors, on the other hand, the starting concentrations of TNF-alpha were much lower than in survivors with a peak on day 3 with a tendency to fall on day 7. The profiles of cytokine production by traumatic patients (90% survivors) revealed low and progressively diminishing levels of IL-6, contrasting with constantly increasing concentrations of TNF-alpha within the monitoring period. We conclude that high IL-6 levels in septic patients accompanied by high TNF-alpha levels may indicate bad prognosis. In contrast, rapidly diminishing serum IL-6 levels, even in the presence of high TNF-alpha levels, could indicate a very good chance for survival. Similar conclusion can be drawn from the monitoring of cytokine production in traumatic, nonseptic patients since almost all of them recovered. We also speculate that TNF-alpha presence in circulating blood is essential for regeneration of tissues and wound healing.
本研究旨在监测入住重症监护病房的脓毒症、脓毒性休克和多器官功能障碍综合征患者血浆白细胞介素6（IL-6）和肿瘤坏死因子α（TNF-α）水平。患者接受了充分的支持治疗。入院时采集血浆样本，然后在入院后的第1、2和5天采集。分别使用生物测定法（7TD1和WEHI-164.13指示细胞系）测定IL-6和TNF-α水平。结果显示，脓毒症患者细胞因子释放的动力学在幸存者和非幸存者之间存在显著差异。在幸存者中，IL-6浓度最初较高，入院后第1天迅速下降，并在整个监测期间一直维持在很低水平。相比之下，非幸存者入院时记录的IL-6水平相对较低，在观察第3天达到峰值后显著升高，随后下降。幸存者的TNF-α水平最初高于非幸存者，入院后第1天下降，第5天时高于初始值。另一方面，在非幸存者中，TNF-α的起始浓度远低于幸存者，在第3天达到峰值，第7天有下降趋势。创伤患者（90%为幸存者）的细胞因子产生情况显示，IL-6水平较低且逐渐降低，而在监测期内TNF-α浓度持续升高。我们得出结论，脓毒症患者中高IL-6水平伴高TNF-α水平可能预示预后不良。相反，即使存在高TNF-α水平，血清IL-6水平迅速降低也可能表明存活机会很大。从对创伤性、非脓毒症患者细胞因子产生的监测中也可得出类似结论，因为几乎所有这些患者都康复了。我们还推测，循环血液中存在TNF-α对组织再生和伤口愈合至关重要。
