手术应激对腹部肿瘤患儿血清促肾上腺皮质激素、皮质醇、心钠素及白细胞介素-6水平的影响  

Influence of Operative Stress on Serum Levels of Adrenocorticotrophic Hormone,Cortisol,Atrial Natriuetic Peptide,and Interleukin-6 in Children with Abdominal Neoplasms after Operation

作　　者：刘阳[1] 张书峰[1] 

机构地区：[1]郑州大学第三附属医院小儿外科,郑州450052

出　　处：《实用儿科临床杂志》2009年第23期1811-1812,1825,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨腹部肿瘤患儿手术创伤应激前后血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、心钠素(ANP)与IL-6水平的变化规律及临床意义。方法监测18例腹部肿瘤患儿(男12例,女6例;其中腹腔畸胎瘤8例,肝母细胞瘤、肾母细胞瘤各5例)术前24h,术后4、24、48、72h外周血清ACTH、Cor、ANP和IL-6水平的变化,根据患儿术后恢复情况分为研究组和对照组。研究组为术后出现应激性溃疡、肠梗阻、感染性休克等并发症,甚至死亡的患儿;对照组为术后恢复顺利的患儿。2组患儿血清ACTH、Cor及ANP的数值变化通过放射免疫(RIA)法测定,IL-6水平变化通过双抗夹心ELISA法检测。结果二组ACTH、Cor、ANP和IL-6水平术后4h均较术前明显升高。二组血清ACTH、ANP水平的变化趋势相似。对照组Cor水平在术后24h达峰值后稳定下降,术后72hCor水平与术前接近;IL-6在术后4h达峰值,48h内仍处于高水平状态,术后72h降至术前水平。研究组患儿Cor、IL-6水平在术后24h后呈缓慢上升趋势,至术后72h仍明显高于对照组,差异均有统计学意义(Pa<0.05)。结论手术创伤应激早期可使腹部肿瘤患儿血清ACTH、Cor、ANP和IL-6水平升高,而Cor和IL-6水平的异常变化提示患儿术后恢复欠佳。Objective To investigate the regularity and clinical significance of cortisol（Cor）,adrenocorticotrophic hormone（ACTH）,atrial natriuetic peptide（ANP） and interleukin-6（IL-6） changes before and after operation stress.Methods The ACTH,Cor,ANP and IL-6 levels in 18 children with abdominal neoplasms（12 male and 6 female,8 cases with sacrococcygeal teratoma,5 cases with hepatoblastoma,and 5 cases with nephroblastoma） were measured before and after operation（24 hours before operation;4,24,48,and 72 hours after operation）.Eighteen children were divided into the study group and the control group.The children in the former group were accompanied with stress ulcer,intestinal obstruction and infection shock or even death after operations,while the children in the later group recovered without any complication.The ACTH,Cor,ANP in serum were measured by radioactive immune analysis（RIA） assay,and serum IL-6 level were measured by enzyme linked immunosorbent assay（ELISA）.Results In 2 groups,serum levels of ACTH,Cor,ANP,IL-6 increased significantly 4 h after operation.The changes in ACTH and ANP were similar in 2 groups.Cor in the control group reached its peak 24 h after operation,and then decreased gradually to the pre-operation levels 72 h after operation;IL-6 reached its peak 4 h after operation,and then decreased slowly.It was still at a high level in 48 h after operation,and then decreased to pre-operation levels 72 h after operation.But serum Cor,IL-6 in the study group slightly increased 24 h after operation,and were apparently higher than those in the control group（Pa〈0.05）.Conclusion In the early period,ACTH,Cor,ANP and IL-8 increased,and the abnormality of Cor and IL-6 may be associated with postoperative complications.

关 键 词：手术应激 促肾上腺皮质激素 皮质醇 心钠素 白细胞介素-6 细胞因子 儿童 

分 类 号：R735[医药卫生—肿瘤]