Clinical Study On The Role Of Nuclear Factor-κB In The Pathogenesis And Prognosis Evaluation Of Multiple Organ Dysfunction Syndrome

Objective: (1) To respectively compare the expression of nuclear factor- κB (NF-kB) mRNA, inhibitor kB (IκBα) mRNA in peripheral blood mononuclear cells (PBMC) and the concentration of tumor necrosis factor-a (TNF-a) in blood serum between the patients of survivors and nonsurvivors with multiple organ dysfunction syndrome and control group, and analyze their changing regulation. (2) To discuss the role of NF-kB and TNF-a in the pathogenesis of MODS, and study the relationship between NF-kB expression and the prognosis of MODS. (3) To provide the theoretical basis for the prevention and treatment of MODS.Methods: 30 patients who fulfilled the criteria for MODS were studied. Ten healthy volunteers were also studied. The acute physiology and chronic health evaluation III (APACHE III) score was recorded in the first 24 hours of ICU admission. According to the ICU outcomes, the patients were divided into two groups, survivors (n=17) and nonsurvivors (n=13). NF-kB mRNA and IkBα mRNA levels were established by reverse transcription-polymerase chain reaction (RT-PCR) and quantified by scanning densitometry. TNF-a was evaluated by radioimmunoassay (RIA).Rusults: (1) The mean x±s NF-kB mRNA and IκBa mRNA levels in PBMC, TNF-a concentration in blood serum and APACHE III score in the group of survivors with MODS were 1.247±0.512, 1.372±0.743, 1.578±0.179 ng/ml,48.125±12.699. The mean x±s NF-kB mRNA and IkBα mRNA levels in PBMC, TNF-a concentration in blood serum, the APACHE III score in the group of nosurvivors with MODS were 1.179±0.508, 0.875±0.451, 1.775±0.476 ng/ml,93.250±16.611. The mean x±s NF-kB mRNA and IκBa mRNA levels in PBMC, TNF-a concentration in blood serum in the control group were 0.738±0.238, 1.966±0.666, 0.975±0.183 ng/ml. (2) The expression of NF-kB mRNA in PBMC and the TNF-a concentration in blood serum of survivors and nonsurvivors were higherthan that of the control group (P<0.05). The expression of NF-kB mRNA in PBMC and the TNF-a concentration in blood serum failed to show significant difference between survivors and nonsurvivors(P>0.05). (3) The IkB(x mRNA levels in PBMC of survivors and nosurvivors were lower than that of the control group (P<0.05). The IkB(x mRNA level in PBMC of nonsurvivors were lower than that of survivors (P<0.05). (4) The APACHE III score of nosurvivors were higher than that of survivors (P<0.05).Conclusion: (1) The expression of NF-kB in PBMC and concentration of TNF-a in serum from patients with MODS have significantly increased. NF-kB and TNF-a may play important roles in pathogenesis of MODS. (2) The APACHE III score and the IicBa expression in PBMC appear to be two valuable tool for individual risk evaluation in MODS patients, and have the value to assess the prognosis in patients with MODS.