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目的研究乌司他丁对腹蛇咬伤儿童血清IL-6、IL-10水平的影响。方法 2006年7月-2009年10月本院急诊和普外科收治腹蛇咬伤儿童48例。随机分为乌司他丁治疗组(n=24)、常规治疗组(n=24)。常规治疗组按照经典的局部切开排毒、封闭+抗毒血清+脏器支持保护等治疗,乌司他丁治疗组加用乌司他丁针(10万U静脉滴注,2次.d-1,连续3d后改为5万U静脉滴注,2次.d-1,连续4d),另取健康儿童12例作为健康对照组。所有患儿于治疗前、治疗第1天、第3天及第7天(或死亡)采用ELISA检测其血清中促炎介质IL-6和抗炎介质IL-10水平,代表性评估患者的免疫状态。结果治疗前和治疗第1天2个治疗组IL-6无明显区别,但均明显高于健康对照组,2组于治疗第3天和第7天IL-6水平均明显降低(Pa<0.01),但乌司他丁治疗组较常规治疗组下降更加明显(P<0.05);与健康对照组比较,常规治疗组和乌司他丁治疗组IL-10水平在治疗前和治疗第1天均无明显差异,但第3天、第7天则高于健康对照组(P<0.01),但2个治疗组间无明显差异。其中常规治疗组1例死亡患儿IL-6水平持续增高,而IL-10的水平持续低于健康对照组。结论腹蛇咬伤儿童的免疫状态可出现紊乱,表现为早期促炎介质占优势,后期抗炎介质升高显著,乌司他丁可在一定程度上调节这种免疫状态。
Objective To investigate the effects of ulinastatin on serum IL-6 and IL-10 levels in abdominal snake bites. Methods From July 2006 to October 2009, 48 cases of abdominal snake biting in our hospital emergency room and general surgery department. Randomly divided into ulinastatin treatment group (n = 24), conventional treatment group (n = 24). Conventional treatment group according to the classic local open detoxification, closed + antiseptic serum + organ support and protection treatment, ulinastatin treatment group with ulinastatin needle (100000 U intravenous infusion, 2 times .d- 1, continuously changed to 50000 U intravenous infusion after 3 days, 2 times .d-1, continuous 4d), another 12 healthy children as healthy control group. All children before treatment, on the first day, the third day and the seventh day (or death) were detected by ELISA serum IL-6 and anti-inflammatory mediators in serum IL-10 levels, a representative assessment of the patient’s immune status. Results The levels of IL-6 in the two treatment groups before treatment and on the first day of treatment were not significantly different, but both were significantly higher than those in the healthy control group. The levels of IL-6 in the two groups were significantly decreased on the 3rd and 7th day after treatment (Pa ), But the ulinastatin treatment group decreased more significantly than the conventional treatment group (P <0.05). Compared with the healthy control group, the IL-10 level in the conventional treatment group and the ulinastatin treatment group was significantly lower than before treatment and on the first treatment day No significant difference, but the third day, the seventh day is higher than the healthy control group (P <0.01), but no significant difference between the two treatment groups. The IL-6 level of one death in the routine treatment group was continuously increased, while the level of IL-10 in the routine treatment group was lower than that of the healthy control group. Conclusions The immunological state of abdominal snake biting children may appear disorder, which is characterized by early predominance of proinflammatory mediators and significant increase of antiinflammatory mediators in the late stage. Ulinastatin may regulate this immune state to a certain extent.