原位肝移植围手术期血清TNF-α、IL-6、IL-10的变化  

Perioperative changes in serum levels of TNF-α,IL-6 and IL-10 in peri-operative period of liver orthotopic transplantation

作　　者：杨哲[1] 陈仲清[2] 蒋晓清[2] 

机构地区：[1]兰州军区乌鲁木齐总医院麻醉科,乌鲁木齐830002 [2]南方医科大学南方医院外科ICU

出　　处：《解放军医学杂志》2006年第9期901-903,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨原位肝移植患者在非体外静脉-静脉转流下血清中肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、IL-10的变化规律。方法16例终末期肝病患者,在静吸复合全麻下行肝移植手术,于麻醉后手术前、阻断前、开放前5min、开放后15min、开放后60min、术毕、术后4h、术后24h采集动脉血,用酶联免疫吸附法(ELISA)检测血清中TNF-α、IL-6、IL-10水平。结果术前TNF-α、IL-6维持于较低水平,而IL-10未测得,在无肝期IL-6、IL-10明显上升(P<0·05),开放后3种细胞因子均显著增加(P<0·05),并于开放后60min达峰值,术后24h内TNF-α、IL-6迅速下降至略高于术前水平,IL-10在部分患者未测得。结论肝移植术中由于缺血再灌注损伤及手术应激,机体产生明显的炎症及抗炎反应,以IL-6及IL-10的变化较为灵敏。Objective To study perioperative changes in serum levels of TNF-α, IL-6 and IL-10 in orthotopic liver transplantation without veno-venous bypass. Methods Sixteen patients with terminal liver disease underwent orthotopic liver transplantation under general anesthesia. Samples from arterial blood were obtained at beginning of surgery, before the anhepatic phase, 5min before recirculation, 15min and 60min after recirculation, 4h and 24h after operation, respectively. Serum levels of TNF-α, IL-6 and IL-10 were measured by ELISA. Results TNF-α and IL-6 concentrations were kept at a low level before operation, while IL-10 was not detected. The concentrations of IL- 6 and IL-10 rose during the anhepatic phase （P〈0. 05）. All of them increased rapidly after recirculation and reach the peak point 60min after recirculation （P〈0.05）. The levels of TNF-α and IL-6 declined rapidly within 24h after operation but still higher than that of preoperative levels, and the concentration of IL-10 was not detected in some cases. Conclusion Ischemia and reperfusion injury of liver and surgical stress induce pro- and anti-inflammatory cytokine response during liver transplantation, and IL-6 and IL-10 are more sensitive than TNF-α.

关 键 词：肝移植 肿瘤坏死因子 白细胞介素6 白细胞介素10 

分 类 号：R657.3[医药卫生—外科学]