The Correlation Study Of Plasma TNF-α,IL-1,IL-6 And Hs-CRP In Patients Bitten By Trimeresurus Stejnegeri With Their Limb Swelling Degree And Clinical Classification

Objective To measure the levels of interleukin-1(IL-1),interleukin-6(IL-6),tumor necrosis factor alpha (TNF-a) and hypersensitive c-reactive protein (hs-CRP) in the different groups of patients bitten by Trimeresurus stejnegeri,and to explore their correlations with the degree of limb swelling and severity of the illness.Methods 60 patients bitten by Trimeresurus stejnegeri were selected as experimental group and 15 healthy persons were selected as control group in this study.There was no significant differences between these two groups in gender and age distribution (χ2=0.430, P=0.512>0.05;P=0.539>0.05).The clinical data of every victim was collected. The swelling degree of each victim was assessed according to Snakebite swelling degree,and the experimental group was divided into light, medium and serious group according to the swelling degree.There was no significant differences among these three groups in gender and age distribution (χ2=0.334,P=0.864>0.05;P=0.275>0.05).The clinical classification of each victim was assessed according to the clinical classification and severity score standard of Snakebite, and the experimental group was divided into light, serious and critical group according to the clinical classification.There was no significant differences among these three groups in gender and age distribution (χ2=0.333, P=0.847>0.05;P=0.794>0.05).The levels of TNF-α,IL-1,IL-6 and hs-CRP were measured by the enzyme-linked immunosorbent assay(ELISA) and their differences were compared between experiment group and control group. Meanwhile, The correlation between concentration of these materials and the swelling degree was measured. The correlation between concentration of these materials and the clinical classification was measured.Results 1.The concentration of TNF-a,IL-l,IL-6,hs-CRP in the patients bitten by Trimeresurus stejnegeri were obviously higher than those in the control group(P<0.01).2. There were differences among patients with various swelling degrees. The concentrations of TNF-α,IL-1,IL-6 or hs-CRP in the serious groups were higer than those in light and medium groups and it had significant differences(P<0.05). The levels of TNF-α,IL-1, IL-6 and hs-CRP in the medium groups were higer than those in light groups but there were no statistical differences(P<0.05).There was a positive correlation between serum TNF-α(r=0.562, P<0.01),IL-1(r=0.441, P<0.01),IL-6 (r=0.324, P=0.012<0.01) or hs-CRP (r=0.568, P<0.01) level and swelling degree of patients bitten by Trimeresurus stejnegeri.3. The level of TNF-α,IL-1, IL-6 and hs-CRP varied in different clinical classification groups and they had significantly differences(P<0.05).The higher level of TNF-α,IL-1, IL-6 or hs-CRP was, the worse of patients were; and the differences were statistically different(P<0.05).There was a positive correlation between serum TNF-α(r=0.757, P<0.01),IL-l(r=0.686, P<0.01),IL-6(r =0.736, P<0.01) or hs-CRP(r=0.860, P<0.01) level and clinical classification of patients bitten by Trimeresurus stejnegeri.4.The levels of alanine aminotransferase(ALT), lactate dehydrogenase(LDH) and creatine kinase(CK) in critical group were higher than those of light and serious groups remarkably(P<0.05 or P<0.01). The levels of ALT, LDH and CK in serious group were higher than those of light group and there were significant differences(P<0.05 or P<0.01).5. Patients with serious swelling were easier in a critical condition than those with light or medium swelling(P<0.01).6.There incidence of limb swelling was 20%,61.67%,18.33% in light, medium and serious group respectively within 48 hours after the snakebite of Trimeresurus stejnegeri.Conclusions 1.The serum levers of TNF-α,IL-1,IL-6 and hs-CRP in patients bitten by Trimeresurus stejnegeri tend to elevate within 48 hours after snakebite.2. The increasing of inflammation factors also play an important role in limb swelling caused by Trimeresurus stejnegeri.And there was a positive correlation between plasma inflammatory factors’level and swelling degree of patients bitten by Trimeresurus stejnegeri. Patients with serious swelling had worse inflammatory injuries than those with light or medium swelling and they always came with multiple organ dysfunction or failure.We should pay attention to it in the clinical context.3. The increasing of TNF-α,IL-1,IL-6,hs-CRP,ALT, LDH and CK had remarkable correlation to severity of illness among patients bitten by Trimeresurus stejnegeri within 48 hours and could be references in assessing the state of the illness.