高位硬膜外阻滞对扩张型心肌病患者白细胞介素6及可溶性白细胞介素2受体的影响(英文)  

Effect of high epidural anesthesia on interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy

作　　者：李秀玉[1] 辛晓敏[2] 刘凤岐[3] 

机构地区：[1]首都医科大学宣武医院检验科,北京市100053 [2]哈尔滨医科大学第一临床医学院检验科,黑龙江省哈尔滨市150001 [3]哈尔滨医科大学第一临床医学院心内科,黑龙江省哈尔滨市150001

出　　处：《中国临床康复》2005年第27期187-189,共3页Chinese Journal of Clinical Rehabilitation

基　　金：黑龙江省"十五"科技攻关项目(GB01C126-03)~~

摘　　要：背景:扩张型心肌病患者血清中细胞因子明显升高,心肌组织中也有细胞因子mRNA的表达,通过高位硬膜外阻滞治疗可以阻断细胞因子参与的恶性循环,改善心功能。目的:观察扩张型心肌病患者经过高位硬膜外阻滞术治疗后白细胞介素6及可溶性白细胞介素2受体的变化。设计:病例-对照分析。单位:首都医科大学宣武医院的检验科,哈尔滨医科大学第一临床医院的检验科和心内科。对象:哈尔滨医科大学第一临床医学院心内科2001-10/2002-05的扩张型心肌病患者35例,随机分为高位硬膜外阻滞组和常规治疗组,高位硬膜外阻滞组22例,男15例,女7例;心功能Ⅱ级4例,Ⅲ级9例,Ⅳ级9例。常规治疗组13例,男11例,女2例;心功能Ⅱ级1例,Ⅲ级5例,Ⅳ级7例。同期选择本院的健康体检者21例,男13例,女8例。干预:扩张型心肌病患者分别采用高位硬膜外阻滞治疗及常规治疗,常规治疗组只采用常规治疗方法。所有患者于治疗前及治疗4周后清晨抽取空腹肘静脉血3mL,酶联免疫吸附法测定血清中白细胞介素6和可溶性白细胞介素2受体水平。主要观察指标:各组患者血清中白细胞介素6和可溶性白细胞介素2受体水平。结果:56例观察对象的血样均合格,全部进入结果分析。①扩张型心肌病患者血清白细胞介素6水平(13.9ng/L)明显高于健康对照组(11.22ng/L),(z=-3.072,P<0.05)。②高位硬膜外阻滞治疗组治疗后白细胞介素6水平(11.42ng/L)较治疗前(20.42ng/L)明显下降(z=2.5829,P<0.05)。常规治疗组治疗前后白细胞介素6水平相似(12.16ng/L,12.80ng/L,z=-1.89,P>0.05)。高位硬膜外阻滞组治疗前后白细胞介素6水平差值(-2.04ng/L)明显高于常规治疗组(0.28ng/L),(z=3.1829,P<0.01)。③扩张型心肌病组可溶性白细胞介素2受体水平犤(1306.17±1.46)ng/L犦高于健康对照组犤(1078.95±1.23)ng/L犦,(t=2.51,P<0.05)。④高位硬膜外阻滞治疗组治疗后可溶性白细胞BACKGROUND： Serum cytokines in patients with dilated cardiomyopathy are increased obviously, and the expression of intedeukin-6 mRNA is also observed in myocardial tissues. High epidural anesthesia can block the vicious cycle involving cytokines and improve cardiac function. OBJECTIVE： To observe the changes of intedeukin-6 and soluble interleukin-2 receptor in patients with dilated＂ cardiomyopathy after high epidural anesthesia treatment.DESIGN： A case-controlled analysis. PARTICIPANTS： Thirty-five inpatients with dilated cardiomyopathy were selected from the Department of Cardiology, First Hospital Affiliated to Harbin Medical University, from October 2001 to May 2002. All the patients were randomly divided into high epidural anesthesia group and conventional treatment group. High epidural anesthesia group consisted of 22 patients, 15 males and 7 females, whose cardiac function was classified into grade Ⅱ in 4 patients, grade Ⅲ in 9 and grade Ⅳ in 9. Conventional treatment group consisted of 13 patients, 11 males and 2 females, whose cardiac function was grade Ⅱ in 1 patient, grade Ⅲ in 5 and grade Ⅳ in 7. Healthy control group comprised 21 people, 13 males and 8 females, who received physical examination at the same period. INTERVENTIONS： Patients with dilated cardiomyopathy were treated with high epidural anesthesia and conventional method, whereas those in conventional treatment group were treated with conventional method only. Elbow venous blood of 3 mL was sampled from all patients on empty stomach in the morning before treatment and after 4-week treatment. The level of serum interleukin-6 and soluble interleukin-2 receptor was measured with enzyme-linked immuneadsorbent assay. MAIN OUTCOME MEASURES： The level of serum interleukin-6 and soluble intedeukin-2 receptor of patients in each group. RESULTS： Blood samples of the 56 subjects were qualified and entered the final analysis. ① The level of serum interleukin-6 was higher in dilated cardiomyopathy group （13.9 ng/L） than

关 键 词：心肌病 充血性 神经传导阻滞 白细胞介素6 白细胞介素2受体 可溶性 麻醉 硬膜外 

分 类 号：R542.2[医药卫生—心血管疾病]