肝移植术中BALF成分和TNF-α、IL-1β、IL-8水平的变化及与术后急性肺损伤的关系  

Component and Levels of TNF-α, IL-1β, and IL-8 in Bronchoalveolar Lavage Fluid and Plasma during Liver Transplantation and Their Relation to Postoperative Acute Lung Injury

作　　者：黎尚荣[1] 黑子清[1] 甘小亮[1] 沈宁[1] 程楠[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2008年第2期190-193,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(200711220600476);广东省医学科学基金(A2004212);广东省自然科学基金(7001567)

摘　　要：【目的】观察肝移植术(OLT)中肺泡灌洗液(BALF)的组分和TNF-α、IL-1β、IL-8水平的变化,并探讨它们与术后急性肺损伤(ALI)的关系。【方法】29例患者接受肝移植手术。于麻醉后(T1)及新肝期2h(T2)抽取BALF及动脉血,分析BALF内细胞成分,测定BALF总磷脂含量和总蛋白水平及血浆的蛋白质含量并计算肺通透性;检测BALF及血清TNF-α、IL-1β、IL-8水平,观察术后患者发生ALI的情况,并据此将患者分为ALI组(A组)与非ALI组(N组)。【结果】29例患者中9例(31%)术后发生ALI。A组T1时BALF内巨噬细胞比例低于N组(P<0.05),T2时BALF总蛋白、肺通透性高于N组(P<0.05)。与T1相比,A组BALF总蛋白、肺通透性及总磷脂在T2高于术前值(P<0.05)。A组T2血清及BALF中TNF-α水平和BALF内IL-1β的浓度均高于T1(P<0.05),并高于N组(P<0.05);IL-8浓度变化两组间无差异。T1的BALF内巨噬细胞比例(r=-0.427,P=0.032)、T2的肺通透性(r=0.414,P=0.038)、血清TNF-α(r=0.394,P=0.035)、BALF内TNF-α(r=0.349,P=0.044)、IL-1β(r=0.332,P=0.036)水平与术后ALI的发生有一定相关性。【结论】术中肺泡灌洗液成分和细胞因子水平分析显示新肝期2h会出现变化,ALI组患者更加显著,在肝移植术中麻醉管理应注意肺的保护和减轻炎症反应,可能有利于减少术后ALI的发生。[Objective] To observe the changes of components and levels of TNF-α, IL-1β, and IL-8 in bronchoalveolar lavage fluid （BALF） and plasma during orthotopic liver transplantation （OLT） and to investigate the relationship between the changes and postoperative acute lung injury（ALl）. [Methods] Twenty-nine patients with end-stage liver disease undergoing OLT were enrolled. Arterial blood samples and BALF from the middle lobe of right lung were collected at 2 intervals： after induction （T1） and 120 min after reperfusion （T2） for determinating lung permeability index （BALE protein concentration/serum protein concentration）, the differential cells in BALF, the content of total phospholipids, and the levels of IL-1β, IL-8, and TNF-ot both in BALF and serum. The patients were divided into two groups： ALl group （group A） and Non-ALl group （group N）. [Results]Nine patients （31%） took place with ALl following OLT. The proportion of alveolar macrophage was significantly decreased at T1 in group A while total protein of BALF and lung permeability index significantly increased at T2 compared with group N （P 〈 0.05）. Compare with T1, the total protein and phospholipids of BALF, lung permeability index significantly increased at T2 （P 〈 0.05）. The concentration of TNF-ot in serum and BALF, and IL-1β in BALF at T2 in group A were significantly increased compared with T1 and group N （P 〈 0.05）. There was no significant difference of the concentration of IL-8 between the two groups. The proportion of macrophage at T1, lung permeability index,concentration of TNF-α and IL-1β in BALF, and concentration of TNF-α in serum at T2 were related to postoperative ALI respectively （P 〈 0.05）. [Conclusions] The changes of components and levels of TNF-α, IL-1β, IL-8 in BALF and plasma will be appear in 120 min after reperfusion. It seems more prominence in group ALL Paying attention to lung protection and alleviating inflammatory reaction may be helpful to prevent the appeara

关 键 词：原位肝移植 急性肺损伤 肺泡灌洗液 

分 类 号：R65[医药卫生—外科学]