摘要
目的:观察体外循环(CPB)炎症反应过程中致炎性细胞因子TNF-α、IL-6与中性粒细胞的变化规律及其相关性。方法:选择30例体外循环下行瓣膜置换术的患者,分别于CPB前、CPB40min、CPB停机和停机后2、6、24h以酶联免疫法(ELISA)测定血清TNF-α、IL-6浓度,全血细胞分析仪测定外周血中性粒细胞数量。结果:CPB后各个时间点的血清TNF-α、IL-6浓度和中性粒细胞值较CPB前明显升高,差异有显著性(P<0.01)。血清TNF-α、IL-6水平在CPB开始后,逐渐升高。CPB结束后2h,TNF-α的血清水平达到高峰,CPB结束后24h TNF-α仍维持在很高的水平。血清IL-6水平在CPB结束后6h达到高峰,然后下降,CPB结束后24h仍维持在较高水平。中性粒细胞的变化趋势同TNF-α。2组TNF-α、IL-6血清水平(高峰值)与CPB时间及主动脉阻断(ACC)时间正相关(P<0.01)。围手术期中性粒细胞值与TNF-α、IL-6血清水平有一定的相关性。结论:CPB可触发全身炎症反应,表现为外周血中性粒细胞数量升高与血清TNF-α、IL-6水平升高;CPB和ACC的时间长短影响TNF-α、IL-6的释放,可能影响到术后患者炎性反应的程度;CPB期间血清TNF-α水平与血清IL-6水平、中性粒细胞的升高相关。
Objective：To study the relationship of the changes of amount of neutrophils to concentration of IL-6,TNF-α during cardiopulmonary bypass. Methods：The serum levels of TNF-α,IL-6 were measured by Enzyme Linked Immunosorbent Assay（ELISA） method in patients undergoing heart valve replacement,and the amount of neutrophils was also measured. Serial blood samples were collected at the following intervals respectively：before CPB, 40 min after CPB and 0 h, 2 h, 6 h, 24 h after the end of CPB. Results： The serum levels of TNF-α, IL-6 and the amount of neutrophils after CPB were significantly higher than that before CPB （P 〈 0.01 ）. The serum levels of TNF-α and IL-6 gradually increased after the beginning of CPB. The serum level of TNF-α reached the peak at 2 h after the end of CPB ,and that still maintained a high level at 24 h after the end of CPB. The amount of neutrophils had the similar change. The serum level of IL-6 reached the peak at 6h after the end of CPB,then began to decrease but still higher than the concentration before CPB significantly. The concentration of TNF-α and IL-6 was correlated positively to the time of CPB and ACC （P 〈 0.01 ）. There were correlations between the amount of neutrophils and the concentrations of TNF-α and IL-6. Conclusion： Cardiac surgery with cardiopu]monary bypass （CPB） leads to a systemic inflammatory response syndrome（SIRS） with secretion of cytokines and neutrophils. The time of CPB and ACC influences release of TNF-α and IL-6,so it may change the degree of SIRS in patients after operation. There are correlations between the amount of neutrophils and the concentrations of TNF-α and IL-6 during CPB.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2009年第11期1585-1587,1602,共4页
Journal of Nanjing Medical University(Natural Sciences)
关键词
体外循环
细胞因子
中性粒细胞
全身炎性反应综合征
cardiopulmonary bypass
cytokines
neutrophils
systemic inflammatory response syndrome
