老年人胃癌根治手术围手术期TNF-α、sTNF-RⅠ、IL-6、IL-10和肾功能的变化  

Changes of TNF-α,sTNF-RⅠ,IL-6,IL-10 and renal function in elderly patients during and after gastric cancer surgery

作　　者：杨庆[1] 林群[1] 林献忠[1] 林财珠[1] 

机构地区：[1]福建医科大学附属第一医院麻醉科,福建福州350005

出　　处：《中国现代医学杂志》2009年第1期95-98,共4页China Journal of Modern Medicine

基　　金：福建省卫生厅青年科研基金(2006-1-1)

摘　　要：目的观察老年人胃癌根治手术围手术期细胞因子和肾功能的改变,并探讨围术期炎症反应与肾损伤的关系及其可能的机制。方法全身麻醉下择期行胃癌根治手术的患者40例,分为两组,每组20例:老年组(Ⅰ组)年龄≥65岁,中年组(Ⅱ组)年龄<60岁。分别于麻醉诱导前(T0)、手术开始后1h(T1)、术后第1天(T2)、第3天(T3)和第5天(T4)留取血、尿标本,测定血浆中肿瘤坏死因子α(TNF-α)、可溶性肿瘤坏死因子受体Ⅰ(sTNF-RⅠ)、白介素-6(IL-6)、白介素-10(IL-10)和尿中的肌酐、N-乙酰-β-D氨基葡萄糖苷酶(NAG)、α1微球蛋白(α1-MG)和微量白蛋白(Alb)含量。结果两组患者静脉血TNF-α于T1时点显著高于T0时点(P<0.05),组间比较差异无显著性(P>0.05);两组sTNF-RⅠ于T1至T4均较T0时显著升高(P<0.01),组间比较差异无显著性(P>0.05);两组于T1至T4时点IL-6较T0时显著升高(P<0.05),T2和T3时点Ⅰ组IL-6明显高于Ⅱ组(P<0.05)。两组IL-10于T1和T2时点较T0时显著升高(P<0.01),但Ⅰ组升高的幅度明显低于Ⅱ组(P<0.05)。Ⅰ组术前尿NAG/Cr明显高于Ⅱ组(P<0.05),两组NAG/Cr和α1-MG/Cr从T1至T4明显高于术前值(P<0.01),Ⅰ组在T4时点尿NAG/Cr明显高于Ⅱ组(P<0.05),而α1-MG/Cr组间比较差异无显著性。两组尿Alb/Cr于T1时点至T2时点显著增加(P<0.01),Ⅰ组明显高于Ⅱ组(P<0.05),Ⅰ组至T4时点恢复到术前值,而Ⅱ组于T3时点恢复到术前值。结论老年患者围手术期肾功能改变较中年患者明显,这可能与老年患者围术期及术后存在更强的促炎症反应程度有关。[Objective] To observe the changes of cytokines and renal function in elderly patients during gastric cancer surgery compared with young adults and investigate the relationship between perioperative inflammation and renal injury. [Methods] 40 patients with elective surgery for gastric carcinoma under general anesthesia were divided into two groups： group Ⅰ, patients aged 65 years or older （N=20）, and group Ⅱ, younger than 60 years （N=20）. Blood samples were analyzed for tumor necrosis factor-α （TNF-α）, soluble TNF receptor- Ⅰ （sTNF-R Ⅰ ）, interleukin-6 （IL-6）, interleukin-10 （IL-10） and urine for creatinine （Cr）, β-N-acetyl-D-glucosaminidase （NAG）, urinary α1-micro globulin （α1-MG）, albumin （Alb） before general anesthesia induction （T0）, 1 h after incision （T1）, on the first （T2, third （T3） and fifth day （T4） postoperatively. [Results] Plasma concentrations of TNF-α rose significantly at T1 and then returned to normal levels without difference between groups. Serum levels of sTNF-R Ⅰ rose significantly from T1 to T4 without difference between groups. Intedeukin-6 （IL-6） at T2, and T3 in Group Ⅰ were significantly higher than those in Group Ⅱ （P 〈0.05）. Serum concentrations of IL-10 were significantly raised at T1 and T2 in both groups with significantly higher in Group Ⅱ （P 〈0.05）. Urinary α1-MG/Cr and NAG/Cr in both groups increased significantly from T1 to T4 （P 〈0.05）, NAG/Cr in Group Ⅰ were significantly higher than those in Group Ⅱ during observation. Alb/Cr in Group Ⅰ rose significantly from T1 to T3 （P 〈0.05）, while Alb/Cr in Group Ⅱ returned to normal level at T3. [Conclusion] Compared with young adult patients, more serious postoperative renal tubule epithelial cell injury in elderly during upper abdomen surgery may be due to more serious pro-inflammatory responses in the aged.

关 键 词：老年人 围手术期 炎症反应 细胞因子 肾功能 尿蛋白 NAG 

分 类 号：R735.2[医药卫生—肿瘤]