体外循环对小儿血浆细胞因子水平及中性粒细胞凋亡的影响  

Effects of Cardiopulmonary Bypass on Levels of Cytokines and Apoptosis of Neutrophils in Paediatric Patients

作　　者：岳立辉[1] 赵砚丽[1] 李建立[1] 刘晓明[1] 杜彦茹[1] 赵志勇[2] 

机构地区：[1]河北省人民医院麻醉科,河北省石家庄市050051 [2]河北省人民医院心外科,河北省石家庄市050051

出　　处：《中国全科医学》2008年第12期1033-1035,共3页Chinese General Practice

基　　金：河北省科学技术与发展计划项目(07276101D-6)

摘　　要：目的通过检测小儿体外循环(CPB)引起的致炎细胞因子肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)和抗炎细胞因子白介素-10(IL-10)的水平及中性粒细胞(PMN)凋亡率的动态变化,探讨CPB前后PMN凋亡及致炎和抗炎细胞因子水平的变化与规律。方法选择于CPB时行室间隔缺损修补术的患儿30例,分别于麻醉诱导前(T0)、麻醉诱导后(T1)、复温前(T2)、停CPB即刻(T3)、术后24h(T4)及48h(T5)6个时间点取外周血,ELISA法检测血浆TNF-α、IL-8和IL-10水平,流式细胞仪测定PMN凋亡率,进行比较分析。结果血浆TNF-α水平、IL-8水平及PMN凋亡率在T2与T0间差异有统计学意义(P<0.05);T3与T0间差异亦有统计学意义(P<0.01);T4、T5与T0间差异均无统计学意义(P>0.05)。血浆IL-10水平在T2、T3、T4与T0间差异均有统计学意义(P<0.01);T5与T0间差异无统计学意义(P>0.05)。CPB结束时,血浆TNF-α水平与PMN凋亡率呈负相关(r=-0.578,P<0.05);血浆IL-8水平与PMN凋亡率呈负相关(r=-0.455,P<0.05);血浆IL-10水平与PMN凋亡率呈正相关(r=0.374,P<0.05)。结论CPB引起致炎细胞因子TNF-α、IL-8水平升高,抗炎细胞因子IL-10水平升高,PMN凋亡率下降;致炎细胞因子TNF-α、IL-8可能抑制PMN的凋亡;抗炎细胞因子IL-10可能促进PMN的凋亡。Objective To probe into the changes of polymorphonuclear neutrophil （PMN） apoptosis and of proinflammatory and anti - inflammatory cytokines and their developing regularity before and after cardiopulmonary bypass （CPB） in paediattic patients, by detecting the levels of proinflammatory factor tumor necrosis factors - α （TNF - α）, interleukin - 8 （ IL - 8） and anti - inflammatory factor interleukin - 10 （ IL - 10）, and the dynamic changes of PMN apoptosis caused by CPB. Methods From 30 child patients （ aged from 1 - 4） , on whom repair of ventricular septal defect was performed in CPB, peripheral blood was taken before anesthesia induction （ T0）, after anesthesia induction （ T1 ）, before rewarming （ T2 ）, instantly after CPB （T3）, at 24 h （T4） and at48 h （T5）, respectively, and the levels of serum TNF -α, IL -8 and Il - 10 were determined by ELISA, and PMN apoptosis by flow cytometry. Results Plasma concentrations of TNF - α and IL - 8 increased significantly after CPB onset as compared with baseline concentrations, got to the peak at the end of CPB （ T3 ） （ P 〈 0. 01 ）, and thereafter droped to the baseline at 24 h after operation （ P 〉 0. 05 ）. IL - 10 also increased markedly after CPB as compared with the baseline, concentrations got to the peak at the end of CPB （T3）, and then decreased back to the baseline at 48 h after operation. Rate of PMN apoptosis decreased significantly after CPB onset, reached its lowest value （ P 〈0. 01 ） at the end of CPB （T3）, and afterward returned to the baseline at 24 h after operation. The highest plasma levels of TNF - α, IL - 8 and IL - 10 were significantly correlated with the rate ofPMN apoptosis （ r = -0.578, P 〈0.05, r = -0.455, P 〈0.05, r =0.374, P 〈0.05, respectively）. Conclusion Proinflammatory and antiinflammatory response results in damages of systemic inflammatory response to CPB in paediatric patients; Pediatric cardiovascular surgery with CPB may lead to depression of apopt

关 键 词：心肺转流术 炎症 细胞因子类 中性粒细胞 细胞凋亡 

分 类 号：R726.541[医药卫生—儿科]