心脏瓣膜置换术体外循环期间TNF-α、IL-6的变化  

Changes of cytokines TNF-α and IL-6 during cardiopulmonary bypass in patients undergoing heart valve replacement

作　　者：马云帆[1] 郭德和[1] 

机构地区：[1]宁夏医学院附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2008年第2期97-99,共3页Ningxia Medical Journal

摘　　要：目的观察心脏瓣膜置换术体外循环(CPB)期间肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平的变化规律。方法选择30例体外循环下行瓣膜置换术的心脏病患者,分别于CPB前、CPB 30分钟、CPB停机、CPB停机后2、6、24小时放免法测定血清中TNF-α、IL-6的浓度。结果CPB后各个时间点的TNF-α、IL-6浓度与CPB前的浓度比较,差异有显著性(P<0.01)。TNF-α、IL-6的血清水平在CPB开始后,逐渐升高。CPB结束后2小时,TNF-α血清水平达到高峰,CPB后24小时TNF-α仍维持在很高的水平。IL-6在CPB结束后6小时达到高峰,然后下降。TNF-α、IL-6血清水平(高峰值)与CPB时间及升主动脉阻断(ACC)时间正相关(P<0.01)。TNF-α血清水平(高峰值)与IL-6血清水平(高峰值)正相关(P<0.01)。结论心脏瓣膜置换术CPB期间促炎细胞因子TNF-α、IL-6释放增加;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;TNF-α血清水平影响IL-6血清水平。Objective To investigate the changes of serum cytokines TNF -α, IL -6 during cardiopulmonary bypass in Iptients undergoing valve replacement. Methods The serum levels of TNF -α, IL - 6 were measured by radioimmunoassay method in 30 patients undergoing valve replacement with cardiopulmonary bypass （CPB）. Serial blood samples were collected at the following intervals respectively： before CPB, 30min after CPB and Oh, 2h, 6h, 24h after the end of CPB. Results The serum levels of TNF -α and IL - 6 after CPB were significantly higher than those before CPB （ P 〈 0.01 ）. The serum levels of TNF -α and IL - 6 gradually increased after the beginning of CPB. The serum levels of TNF -α reached the peak at 2h after the end of CPB, and that still kept a high level at 24h after the end of CPB. The serum levels of IL - 6 reached the peak at 6h after the end of CPB, and then began to decrease. The concentration of TNF -α and IL - 6 was correlated positively to the time of CPB and ACC（ P 〈0.01 ）. There was a significant positive correlation between the concentration of TNF -α and that of IL - 6 （ P 〈 0.01 ）. Conclusion Serum pro - inflammatory cytokines TNF -α, IL - 6 is increased during CPB in patients undergoing valve replacement. The time of CPB and ACC may affect release of TNF -α and IL - 6, so it may change degree of SIRS in patients after operation.

关 键 词：体外循环 TNF-α IL-6 炎症反应综合征 心脏瓣膜置换 

分 类 号：R654.2[医药卫生—外科学]