白细胞介素-8基因多态性与老年人非体外循环下冠状动脉旁路移植术预后的相关性  

Relationship of interleukin-8 polymorphism and prognosis of elderly patients undergoing off-pump coronary artery bypass grafting

作　　者：王赞鑫[1] 邵洁[2] 周清华[3] 刘建实 朱彧[3] 杨洁[2] 魏民新[1] 

机构地区：[1]天津医科大学总医院心血管外科,300052 [2]天津医科大学免疫学教研室 [3]天津市肺癌研究所 [4]无津胸科医院心外科

出　　处：《中华老年医学杂志》2010年第7期582-586,共5页Chinese Journal of Geriatrics

基　　金：天津市科委重点攻关计划（05YFSZSF02700）;天津市科委自然科学基金（06YFJMJC08700）;天津市卫生局重点课题（04KY03）

摘　　要：目的 研究白细胞介素-8（IL-8）在围手术期的变化及其与基因多态性关系,探讨心脏手术后炎性反应与预后的相关性.方法 术前分析IL-8（-251A〉T）基因多态性.并于术前、术后4 h、24 h、72 h获取血液标本检测细胞因子.同时记录手术情况及对应时间点患者肌钙蛋白T（TnT）、肌酸激酶同工酶（CKMB）和血肌酐等生化指标.结果 145名患者首次接受择期非体外循环下冠状动脉旁路移植术,术后患者血浆IL-8水平上升,术后4 h水平最高（18.0[8.4,37.1]ng/L,P=0.000）,术后3 d已下降至接近术前水平.其中-251AA基因型患者术后4 h IL-8水平产量升高（33.1[16.6,49.5]ng/L）（P=0.035）.IL-8-251AA基因型患者,TnT和CKMB水平于术后4 h高于AT和TT基因型患者（TnT：0.53[0.43,4.92]ng/ml,P=0.037;CKMB：41.5[28.8,65.5]U/L,P=0.025）;AA基因型患者血肌酐水平于术后24 h升高（93.1[76.4,121.5]μmol/L,P＝0.021）.手术后呼吸机使用〉1 d或术后住院时间〉14 d患者,术后4 h IL-8水平升高（P=0.036,0.038）.应用Logistic回归方法对术后出现呼吸机使用〉1 d,术后住院〉14 d等危险因素进行回归分析发现,IL-8-251AA患者呼吸机使用〉1 d（OR＝11.80,95% CI：1.87～74.48）,术后住院〉14 d（OR=38.00,95% CI：4.15～347.87）风险增加.结论 非体外循环下冠状动脉旁路移植术会引起机体炎性反应.IL-8-251AA基因型患者术后炎性反应程度及预后风险增加,手术后炎性反应程度和预后与遗传背景有关.Objective To observe the change of interleukin-8（IL-8） during perioperative period, and to define whether the increase of IL-8 in response to cardiac surgery is related to the presence of a certain allele in a functional polymorphism. To explore the relationship between postoperative inflammation and clinical outcome. Methods One hundred and forty-five patients undergoing selective off-pump coronary artery bypass （OPCAB） for the first time were enrolled. The IL-8 （-251A 〉T） polymorphisms were analyzed by using polymerase chain reaction （PCR） and gene sequencing. The plasma levels of cytokine, troponin T （TnT）. creatine kinase-MB （CK-MB） and creatinine （Cr） were measured before and 4, 24 and 72 hours after operation by suspension array system. Results After surgery, the IL-8 concentration increased and reached the highest level at 4 hours after surgery [18.0 （8.4, 37.1） ng/L, P = 0.000], and then it decreased to the preoperative level at 3 days after surgery. Four hours after surgery, the patients with IL-8-251 AA homozygous genotype had higher concentration of IL-8 C33.1 （16.6, 49.5） ng/L, P =0.0353. They had higher TnT and CK-MB levels than patients homozygous for AT and TT genotype 4 hours after surgery [TnT：0.53 （0.43, 4.92） ng/ml, P = 0.037; CK-MB： 41.5 （28.8, 65.5） U/L, P=0.025], and patients homozygous for AT genotype had higher Cr level 24 hours after surgery C93.1 （76.4, 121.5） μmol/L, P = 0. 021]. The patients who underwent ventilation for more than 1 day or post-operative hospital stay for more than 14 days had higher IL-8 levels （P=0.036, 0.038）. IL-8-251AA genotype was an independent risk factor for patients undergoing ventilation for more than 1 day （OR=11.80, 95% CI： 1.87-74.48） and post-operative hospital stay for more than 14 days （OR=38.00, 95% CI：4.15-347. 87） . Conclusions OPCAB results in postoperative inflammatory response. IL-8-251AA genotype is associated with longer mechanical ventilation and hospital staying. Genetic b

关 键 词：白细胞介素 基因多态性 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]