腹部大手术后杀菌/通透性增加蛋白的变化规律及意义  

Significance of fluctuated level of endogenous bactericidal/permeability-increasing protein in patients after major abdominal surgery

作　　者：张立天[1] 姚咏明[1] 陆家齐[1] 于燕[1] 

机构地区：[1]解放军总医院第一附属医院全军烧伤研究所,北京100037

出　　处：《解放军医学杂志》2007年第4期377-379,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家重点基础研究发展规划项目(2005CB522602);国家杰出青年科学基金课题(30125020);首都医学发展科研基金重点项目(2003-2023)

摘　　要：目的观察外科大手术后内源性杀菌/通透性增加蛋白(BPI)的变化规律及其临床意义。方法选择拟行腹部大手术患者11例,分别于术前和术后1、3、5、7、14天采集血标本,测定外周血中性粒细胞数的变化,并采用ELISA方法测定血浆BPI、脂多糖结合蛋白(LBP)和IL-6水平,改良基质显色法鲎试验检测血浆内毒素含量。结果正常对照组血浆中BPI/LBP比值为(0.672±0.083)×10-3,腹部大手术后第1天增高至(1.058±0.074)×10-3(P=0.004),第3天为(1.107±0.061)×10-3(P=0.001),第5天后降至正常范围(P>0.05)。11例患者术前血浆中均未检测到IL-6,腹部大手术后第1天血浆中IL-6水平迅速增高达峰值(27.440±12.144pg/ml,P=0.04),第3天仍处于较高水平(11.530±5.312pg/ml)。结论手术创伤后机体内源性BPI的增幅明显高于LBP,可能有助于控制大手术后内毒素血症的发生及发展。Objective To investigate the fluctuated pattern of endogenous bactericidal/permeability-increasing protein （BPI） levels, and to elucidate its significance in endotoxin response after major abdominal surgery. Methods Eleven patients undergoing major abdominal surgery were involved in present study. The levels of plasma BPI, lipopolysaccbaride-binding protein （LBP） and interleukin-6 （IL-6） were measured preoperatively and on postoperative days 1, 3, 5, 7, and 14 by ELISA. Plasma endotoxin concentration was determined with the chromogenic limulus amebocyte lysate （LAL）, which was modified by perchloric acid （PCA） pretreatment of samples. The polymorphonuclear neutrophil count was also done at each time point. Results In comparison with normal controls, plasma BPI/LBP ratios [（1. 058±0. 074）×10^-3, P=0. 004] were significantly increased on postoperative day 1, maintained at same level on day 3, and declined on day 5. No plasma IL-6 was detected from the blood of all the 11 patients prior to operation, but plasma IL-6 level rose rapidly on day 1 after operation （27. 440± 12. 144pg/ml, P=0. 04）, maintaining a high level （11. 530±5. 312pg/ml） on postoperative day 3, and disappeared on day 5. Conclusions Plasma BPI/LBP ratios were markedly elevated during 3 days after a major abdominal surgery, and endogenous elevated BPI may play an important role in prevention from the development of endotoxemia in surgical patients.

关 键 词：杀菌/通透性增加蛋白 脂多糖结合蛋白 细胞因子类 外科手术 

分 类 号：R656[医药卫生—外科学]