The analysis of relationship between intestinal barrier function injury and inflammatory cytokines in early heat stroke patients

doi:10.3877/cma.j.issn.2096-1537.2018.04.008

Abstract

Abstract:

Objective

To investigate observe intestinal barrier function injury in early heat stroke patients,and explore its correlation with inflammatory cytokines.

Methods

14 patients diagnosed with heat stroke were divided into early group (7 cases) or late group (7 cases) by whether the onset of heat stroke was more than 3 h. The blood from each patients was collected for detection of immune cells, inflammatory cytokines and intestinal barrier function.

Results

Mean arterial pressure was significantly higher in late group [(73.28±7.49) mmHg vs (90.23±16.25) mmHg, P=0.028, 1 mmHg=0.133 kPa]. APACHE Ⅱ scores, mortality rate, level of interleukin-2 receptor, interleukin-6, interleukin-8 and interleukin-10 were significantly higher in late group [APACHE Ⅱscores: (25.71±3.04) scores vs (20.14±2.91) scores, P=0.004; mortality: 28.6% vs 0, P=0.000; IL-2 receptor: (738.00±197.40) U/ml vs (159.80±67.79) U/ml, P=0.025; IL-6: (380.10±401.90) pg/ml vs (6.72±3.38) pg/ml, P=0.049; IL-8: (2850.51±3512.88) pg/ml vs (33.35±28.27) pg/ml, P=0.023; IL-10: (497.20±470.60) pg/ml vs (41.55±66.47) pg/ml, P=0.043]. The total area under the ROC curves of interleukin-10 for liver function damage was 0.893. Interleukin-10 at a level of 92.5 was with best diagnostic accuracy, with sensitivityof 71.4%, and specificity of 100.0%.

Conclusion

Heat stroke within 3 hours of onset had a better prognosis. IL-6 is a good indicator for clinical severity in heat stroke. IL-10 can be used as an early warning marker of liver dysfunction in heat stroke.

Key words: Thermoplasty, Interleukin-6, Interleukin-8, Interleukin-10, Intestinal mucosa barrier, Systemic inflammatory response

Rui Tian, Yun Xie, Jiang Du, Wei Jin, Jian Lu, Hui Xie, Xian Zhu, Ruijie Cheng, Hui LYU, Chengbin Yuan, Ruilan Wang. The analysis of relationship between intestinal barrier function injury and inflammatory cytokines in early heat stroke patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(04): 333-337.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2018.04.008

https://icu.cma-cmc.com.cn/EN/Y2018/V04/I04/333

Figures/Tables 5

References 21

1	Du Y, Xu JT, Jin HN, et al. Increased cerebral expressions of MMPs, CLDN5, OCLN, ZO1 and AQPs are associated with brain edema following fatal heat stroke [J]. Sci Rep, 2017, 7(1): 1691.
2	Leon LR, Helwig BG, Leon LR, et al. Heat stroke: role of the systemic inflammatory response [J]. J Appl Physiol, 2010, 109(6): 1980-1988.
3	People′s Liberation Army Professional Committee of Critical Care Medicine. Expert consensus on standardized diagnosis and treatment for heat stroke [J]. Mil Med Res, 2016, 3: 1.
4	Vargas N, Marino F. Heat stress, gastrointestinal permeability and interleukin-6 signaling—Implications for exercise performance and fatigue [J]. Temperature (Austin), 2016, 3(2): 240-251.
5	Deshwal R, Tiwari D, Singh R. Clinical and biochemical characteristics of exertional heat stroke among paratroopers in Agra, India [J]. J Assoc Physicians India, 2017, 65(2): 57-61.
6	Zhang L, Fan X, Zhong Z, et al. Association of plasma DAO and iFABP with severity of disease in patient with heat stroke [J]. Am J Emerg Med, 2015, 33(7): 867-871.
7	Mo WC, Gao X, Liu GP, et al. Heat-related illness in Jinshan District of Shanghai: A retrospective analysis of 70 patients [J]. World J Emerg Med, 2014, 5(4): 286-290.
8	Liu F, Yin J, Du M, et al. Heat-stress-induced damage to porcine small intestinal epithelium associated with downregulation of epithelial growth factor signaling [J]. J Anim Sci, 2009, 87(6): 1941-1949.
9	Berlot G, Marcer G, Zornada F, et al. Heat stroke: Clinical experience from an Italian ICU during summer 2015 [J]. Eur J Int Med, 2016, 33: e11-e12.
10	Leon LR, Bouchama A. Heat Stroke [M]// Comprehensive Physiology [A]. John Wiley & Sons, Inc. 2015: 1030.
11	Bouchama A, Knochel JP. Heat stroke [J]. New Engl J Med, 2015, 346(25): 1978-1988.
12	Lim CL, Mackinnon LT. The roles of exercise-induced immune system disturbances in the pathology of heat stroke: the dual pathway model of heat stroke [J]. Sport Med, 2006, 36(1): 39-64.
13	Masood U, Sharma A, Syed W, et al. Bowel ischemia from heat stroke: A rare presentation of an uncommon complication [J]. Case Rep Med, 2016, 2016(8): 1-3.
14	Xing Z, Gauldie J, Cox G, et al. IL-6 is an antiinflammatory cytokine required for controlling local or systemic acute inflammatory responses [J]. J Clin Invest, 1998, 101(2): 311.
15	Yoshizawa T, Omori K, Takeuchi Ⅰ, et al. Heat stroke with bimodal rhabdomyolysis: a case report and review of the literature [J]. J Intensive Care, 2016, 4(1): 71.
16	Roberts WO. Exertional heat stroke and the evolution of field care: A physician′s perspective [J]. Temperature (Austin), 2017, 4(2): 101-103.
17	Leon LR. Heat stroke and cytokines [J]. Prog Brain Res, 2007, 162: 481-524.
18	Misset B, De JB, Bastuji-Garin S, et al. Mortality of patients with heatstroke admitted to intensive care units during the 2003 heat wave in France: a national multiple-center risk-factor study [J]. Crit Care Med, 2006, 34(4): 1087-1092.
19	Rodriguez-Fernandez M, Grosman B, Yuraszeck TM, et al. Modeling the intra- and extracellular cytokine signaling pathway under heat stroke in the liver [J]. PLoS One, 2013, 8(9): e73393.
20	Sampson JH, Schmittling RJ, Archer GE, et al. A pilot study of IL-2R blockade during lymphopenia depletes regulatory T-cells and correlates with enhanced immunity in patients with glioblastoma [J]. PLoS One, 2012, 7(2): e31046.
21	Topolovec-Vranic J, Pollmann-Mudryj MA, Ouchterlony D, et al. The value of serum biomarkers in prediction models of outcome after mild traumatic brain injury [J]. J Trauma, 2011, 71(1): 478-486.

指标	早期就诊组（7例）	晚期就诊组（7例）	P值
平均就诊时间（h）	2.167±1.033	6.000±3.098	0.028
提问（肛温）（℃）	40.10±0.76	39.47±1.56	0.036
平均动脉压（mmHg）	90.23±16.25	73.28±7.49	0.028
APACHE Ⅱ评分	20.14±2.91	25.71±3.04	0.004
SOFA评分	9.29±2.22	10.43±2.69	0.403
DIC评分	2.71±0.76	3.86±1.46	0.091
入住ICU时间（d）	5.43±1.13	8.57±5.35	0.154
机械通气时间（d）	2.28±1.60	5.57±4.12	0.073
死亡［例（%）］	0（0）	2（28.6）	0

指标	早期就诊组（7例）	晚期就诊组（7例）	P值
平均就诊时间（h）	2.167±1.033	6.000±3.098	0.028
提问（肛温）（℃）	40.10±0.76	39.47±1.56	0.036
平均动脉压（mmHg）	90.23±16.25	73.28±7.49	0.028
APACHE Ⅱ评分	20.14±2.91	25.71±3.04	0.004
SOFA评分	9.29±2.22	10.43±2.69	0.403
DIC评分	2.71±0.76	3.86±1.46	0.091
入住ICU时间（d）	5.43±1.13	8.57±5.35	0.154
机械通气时间（d）	2.28±1.60	5.57±4.12	0.073
死亡［例（%）］	0（0）	2（28.6）	0

指标	早期就诊组（7例）	晚期就诊组（7例）	正常值	P值
IL-1β（pg/ml）	5.00±0.00	78.97±182.73	0~5.0	0.325
IL-2受体（U/ml）	159.80±67.79	738.00±197.40	223.0~710.0	0.025
IL-6（pg/ml）	6.72±3.38	380.10±401.90	0~3.4	0.049
IL-8（pg/ml）	33.35±28.27	2850.51±3511.88	0~62.0	0.023
IL-10（pg/ml）	41.55±66.47	497.20±470.60	0~9.1	0.043
TNF-α（pg/ml）	5.27±1.00	28.94±40.17	0~8.1	0.279
NSE（ng/ml）	18.26±3.67	39.05±56.44	0~16.3	0.368

指标	早期就诊组（7例）	晚期就诊组（7例）	正常值	P值
IL-1β（pg/ml）	5.00±0.00	78.97±182.73	0~5.0	0.325
IL-2受体（U/ml）	159.80±67.79	738.00±197.40	223.0~710.0	0.025
IL-6（pg/ml）	6.72±3.38	380.10±401.90	0~3.4	0.049
IL-8（pg/ml）	33.35±28.27	2850.51±3511.88	0~62.0	0.023
IL-10（pg/ml）	41.55±66.47	497.20±470.60	0~9.1	0.043
TNF-α（pg/ml）	5.27±1.00	28.94±40.17	0~8.1	0.279
NSE（ng/ml）	18.26±3.67	39.05±56.44	0~16.3	0.368

指标	早期就诊组（7例）	晚期就诊组（7例）	正常值	P值
CD3细胞数	301.0±110.3	566.7±381.2	-	0.151
CD4细胞数	183.0±55.2	345.0±245.9	-	0.406
CD8细胞数	95.0±46.7	181.4±124.8	-	0.189
CD3（%）	54.76±8.11	60.30±14.88	61.1~77	0.514
CD4（%）	33.58±4.74	35.89±11.45	25.8~41.6	0.714
CD25（%）	3.10±.283	3.31±1.63	-	0.865
CD8（%）	16.43±5.42	19.40±6.55	18.1~29.6	0.458
CD3^＋HLA-DR^＋（%）	3.30±0.989	2.83±1.73	0.8~3.5	0.732
CD3^＋CD69^＋（%）	2.45±1.20	2.47±1.28	1.2~5.8	0.984
CD4/CD8	2.250±0.936	1.960±0.649	0.98~1.94	0.984

Please choose a citation manager

Content to export