| Paraquat (paraquat, PQ) is the world's widely used herbicide, has become in many places, be the second pesticide poisoning.following organophosphate poisoning. PQP main clinical features of lung injury is mainly of multiple organ dysfunction syndrome (Multiple organ dysfunction syndrome, MODS), MODS PQP and pulmonary fibrosis are the main causes of death, mortality up to 80%. PQP induced MODS and the pathogenesis of pulmonary fibrosis is still at the exploratory stage, the current studies suggest that matrix metalloproteinases (MMPs) and inflammatory mediators involved in the MODS and the pathogenesis of pulmonary fibrosis, but past research mainly concentrated in the sepsis , trauma, shock and chronic interstitial lung disease. The MMPs and inflammatory mediators in the pathogenesis PQP role and MMPs and inflammatory mediators associated with the prognosis PQP research has yet to see a detailed report at home and abroad, the study by observing PQP serum MMP-9, TNF-α, IL-6 of the level of change, analysis of serum MMP-9, TNF-αand IL-6 levels and the degree of PQP patients and prognosis study MMP-9 and inflammatory mediators at PQP role, to evaluate their effect on prognosis for clinical early assessment of the disease, determine prognosis and guide treatment and provide a theoretical basis.Purpose:PQP by detecting serum MMP-9, TNF-αand IL-6 levels, and dynamic observation of MMP-9 and changes in inflammatory mediators and to compare the survival group and death group MMP-9, TNF-α, IL-6 levels and APACHEII differences. Research MMP-9 and inflammatory mediators at the role of PQP explore PQP serum MMP-9, TNF-α, IL-6 levels and PQP prognosis.Methods:Retrospective analysis in January 2005 ~ December 2008 PQP in my Section treated patients with a total of 58 cases, divided into the survival group (n = 18) and death group (n = 40), selected 15 cases of healthy adults as normal control group, using double-antibody sandwich enzyme-linked immunosorbent assay (ELASA) Determination of 1,3,7 days after admission in patients with serum MMP-9, TNF-αand IL-6 level; and use of acute physiology and chronic health evaluation II (APACHE II) system on the degree of illness in patients with score. Serum MMP-9, TNF-αand IL-6 levels compared among the three groups using one-way ANOVA, comparing the use of 22 SNK-q test. APACHE II groups compared with Mann-Whitney t test. Correlation analysis using Spearman rank correlation analysis.Results:Survival group and death group of serum MMP-9, TNF-αand IL-6 levels compared with the control group significantly increased, the difference was significant (P <0.05); death group of serum MMP-9, TNF-αand IL-6 levels higher than the survival group, the two groups statistically significant difference compared with (P <0.01). PQP APACHEII of death in patients group was higher than the survival group (P <0.05); serum MMP-9, TNF-αand IL-6 levels and APACHEII has obvious relevance, the results of correlation analysis: IL-6> TNF-α> MMP -9.Discussion:PQP induced MODS and the pathogenesis of pulmonary fibrosis complicated and is generally believed that oxygen free radicals in the pathogenesis is an important role to play. In recent years, people begin to pay attention to acute poisoning with SIRS (Systemic inflammatory reaction syndrome, SIRS) and MODS relationship, substantial studies have shown that the body in the state of stress can be caused by inflammatory mediators in a variety of ways, "waterfall-like" release, excessive release of inflammatory mediators can cause tissue and organ damage, further development of MODS. It has been confirmed to participate in the inflammatory mediators MODS mainly TNF-α, IL-6, IL-8, IL-10 and so on, further research indicates that inflammatory mediators involved in the early inflammatory response and organ dysfunction process, which by activation of cytokine network induced SIRS, systemic metabolic cause hyperthyroidism, microcirculation injury and MODS, Dougnac study found that patients with sepsis, such as serum IL-6 levels were significantly increased, and with the severity of the disease, IL-6 can be used for the evaluation of SIRS and MODS the degree can be used as indicators of its detection. Pulmonary interstitial fibrosis in the development process, Inflammatory mediators in the role played by the growing emphasis ,It is reported that there is a variety of inflammatory mediators (such as TNF-α, IL-6, IL-10, etc.) involved in post-PQP the pathogenesis of pulmonary fibrosis. The results of this study show PQP serum TNF-α, IL-6 levels compared with normal control group was significantly increased (P <0.05), the death of patients with serum TNF-α, IL-6 levels higher than the survival group, two-phase than there is difference in statistical significance (P <0.01), showed that patients with the disease PQP happen, the development process over the release of inflammatory mediators, excessive inflammatory response and MODS are PQP triggered one of the major causes of pulmonary fibrosis.PQP pathogenesis of the current study also focused on changes in a variety of enzymes, the study found that, MMP-9 are closely related with MODS and pulmonary fibrosis. MMPs are MMP-9 terminal factor family, one under normal circumstances the expression of MMP-9 is small, but in bacteria, toxins, foreign-derived cytokines and the stimulation of endogenous factors, activation of neutrophils cells, endothelial cells can release a large number of MMP-9, thereby undermining the vascular basement membrane and the organizational structure, resulting in tissues, organs damage. In addition, MMPs are the main functions of extracellular matrix degradation, but also with the extracellular matrix is closely related to pulmonary fibrosis, a study showed that, MMP-9 levels of extracellular matrix marked the injury and damage; Selective knockout MMP-9 gene can reduce the mortality rate of endotoxemia; HE Zhi-Jie, such as through dynamic observation of MODS in patients with serum levels of MMP-9 Change that MMP-9 levels in patients with MODS can be used as early warning indicators of poor prognosis. The results of this study show that: PQP serum MMP-9 levels were significantly higher than the normal control group, the death group was higher than the survival group, suggesting that MMP-9 at PQP MODS induced pulmonary fibrosis and play an important role, are probably PQP condition deteriorated The main involvement of factors. APACHE II score is widely used in critical illness scoring system, since 1985 scholars from the United States after Knaus, reported in the literature on sepsis and other non-acute poisoning caused by MODS with good condition and prognosis to determine the value. XU Shu-Yun, etc. through 66 cases of patients with confirmed PQP APACHEII PQP scoring system can be used in patients with severity of disease and prognosis assessment, The results of this study show that the death group was higher than the survival group (P <0.01), Spearman rank correlation analysis revealed that: Serum MMP-9, TNF-α, IL-6 levels and APACHE II has relevance, relevance followed by IL -6> TNF-α> MMP-9.Conclusion:MMP-9, TNF-αand IL-6 involved in the pathogenesis of PQP, serum MMP-9, TNF-α, IL-6 levels continued to rise in patients with poor prognosis tips can be used as the severity of the disease PQP patients and transgenic return predictor.
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