粒细胞集落刺激因子对瓣膜置换患者肾功能、外周血内皮祖细胞和炎性因子的影响  

Effects of granulocyte colony-stimulating factor on the renal function,endothelial progenitor cells and inflammatory factors in patients undergoing heart valve replacement

作　　者：易俊[1] 许飚[1] 胡若愚[1] 李好[1] 景华[1] 

机构地区：[1]第二军医大学南京临床医学院(南京军区南京总医院)心胸外科,南京医学博士研究生210002

出　　处：《医学研究生学报》2012年第4期352-356,共5页Journal of Medical Postgraduates

基　　金：国家自然科学基金(30972969)

摘　　要：目的观察接受心肺转流术(cardiopulmonary bypass,CPB)瓣膜置换手术的患者,应用粒细胞集落刺激因子(granulocyte colony stimulating factor,G-CSF)动员后,肾功能、外周血内皮祖细胞(endothelial progenitor cells,EPCs)和炎性因子的变化,探讨动员剂G-CSF对CPB瓣膜置换术后患者肾功能、EPCs及炎性因子的影响。方法将40例患者随机分为治疗组(G-CSF,600μg/d,术前共7d)和对照组(不施加干预),每组20例。患者入院时(T1)、术后第1天(T2)、术后第3天(T3)以及术后第7天(T4)采集外周血,测定肌酐(serum creatinine,SCr)、胱抑素C(cystatine C,CysC),计算肾小球滤过率(glomerularfiltration rate,GFR);分离、培养EPCs、并测定其数量。检测2组患者血C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumornecrosis factor-α,TNF-α)、基质细胞衍生因子-1(stromal cell-derived factor-1,SDF-1)的水平。结果入院时,2组患者各项指标差异无统计学意义(P>0.05)。术后第1天,2组GFR水平低于术前,其余指标均高于术前(P<0.05);治疗组炎性因子水平较对照组降低(P<0.05),GFR、SDF-1、EPCs数量较对照组升高(P<0.05)。术后第3天,2组患者GFR水平均达到最低谷,其余指标均高于术前(P<0.05);治疗组患者肾功能损害比对照组轻,SDF-1、EPCs数量较对照组明显升高(P<0.01),IL-6、TNF-α差异无统计学意义(P>0.05)。术后第7天,2组患者EPCs数量、SDF-1水平均持续增高,但治疗组比对照组变化更加显著(P<0.01)。SDF-1浓度与循环EPCs数量呈正相关,治疗组CRP比对照组明显降低(P<0.05)。结论 CPB患者术后肾功能在第3天明显降低,第7天逐渐恢复至术前水平。G-CSF可增高SDF-1的水平,有效动员CPB瓣膜置换患者外周血EPCs,亦可降低CRP,对术后肾功能起到保护作用。Objective This study aims to investigate the effects of granulocyte colony stimulating factor（G-CSF） on endothelial progenitor cells（EPCs）,inflammatory factors and renal function in patients undergoing heart valve replacement with cardiopulmonary bypass（CPB）.Methods Forty patients were randomly divided into a G-CSF and a control group,the former treated preoperatively with G-CSF at 600 μg per day for 7 days,while the latter left untreated.The count of EPCs and plasma levels of C-reactive protein（CRP）,interleukin-6（IL-6）,tumor necrotic factor-α（TNF-α）,stromal cell-derivedfactor-1（SDF-1） and serum creatinine were detected preoperatively（Tl） and on postoperative day 1（T2）,3（T3） and 7（T4）,respectively.The glomerular filtration rate（GFR） was calculated by the Cockcroft-Gault formula.Results There were no significant differences in the above indicators between the two groups of patients at admission（P0.05）.On T2,GFR was decreased while the others were increased（P0.05） in both groups,and the levels of Scr,CysC,CRP,IL-6 and TNF-α were markedly lower,but GFR,SDF-1 and EPCs remarkably higher in the G-CSF than in the control group（P0.05）.On T3,GFR dropped to the lowest level in both groups;all the other indexes were higher than on T1（P0.05）;the levels of SCr,CysC and CRP were significantly lower while GFR,SDF-1 and EPCs markedly higher in the G-CSF than in the control group（P0.01）,but there were no significant differences in IL-6 and TNF-α between the two groups（P0.05）.On T4,the count of EPCs and the level of SDF-1 continued to increase,more significantly in the G-CSF than in the control group（P0.01）,and with a positive correlation between the concentration of SDF-1 and the count of EPCs;the plasma level of CRP was significantly lower in the former than in the latter group（P0.05）.Conclusion The renal function is significantly decreased in patients undergoing heart valve replacement with CPB in the first 3 postoperative days,and gradually re

关 键 词：内皮祖细胞 心肺转流术 瓣膜置换 粒细胞集落刺激因子 炎性因子 肾功能 

分 类 号：R446.11[医药卫生—诊断学]