肝移植术后早期合并脓毒症患者外周血炎症因子的变化特点  

The change of plasma inflammatory cytokine in liver transplant patients with early sepsis

作　　者：李敏如[1,2] 汪根树[1,2] 张琪[1,2] 赵辉[1,2] 陈规划[1,2] 

机构地区：[1]中山大学附属第三医院肝移植中心 [2]中山大学器官移植研究所广东省器官移植中心,广州510630

出　　处：《器官移植》2012年第2期102-105,111,共5页Organ Transplantation

基　　金：国家重点基础研究发展计划(973计划)课题(2009CB522404);国家十一五科技重大专项课题(2008ZX10002-026);国家自然科学基金(30972914);广东省科技计划项目重大专项(2007A032000001);广东省医学科学基金(B20080850);广州市科技计划项目(2009Z1-211)

摘　　要：目的研究肝移植术后患者发生早期脓毒症时外周血炎症因子的动态变化特点。方法 19例肝移植患者,根据术后早期(14 d内)有否发生脓毒症分成脓毒症组(9例)和非脓毒症组(10例),比较两组患者术前30 min、术后1 d、3 d、7 d、14 d外周血炎症因子的动态变化和差异。结果 9例脓毒症的平均诊断时间为6 d。两组患者肿瘤坏死因子(TNF)-α、白介素(IL)-10水平在术后1 d稍有上升(P>0.05),之后下降,其中非脓毒症组一直维持在较低水平,而脓毒症组TNF-α于术后7 d再次上升。非脓毒症组术后高迁移率族蛋白B1(high mobility group box 1 protein,HMGB1)信使核糖核酸(messenger ribonucleic acid,mRNA)表达水平较术前有所升高,术后3 d达到高峰后逐渐下降,术后14 d回复至术前水平;脓毒血症组术后HMGB1 mRNA表达均较术前显著上升,并一直维持在较高水平,其在术后各时间点表达均显著高于非脓毒症组(均为P<0.05)。结论肝移植患者发生术后早期脓毒症时,外周血TNF-α上升时间与脓毒症发生时间是平行的,IL-10上升时间晚于TNF-α,但两个指标都并非持续升高,而HMGB1于脓毒症发病早期已明显升高,并一直维持较高水平。提示动态监测HMGB1的表达水平有助于预测肝移植术后早期脓毒症的发生。Objective To observe the dynamic change of serum inflammatory cytokine in liver transplant patients with early sepsis.Methods 19 liver transplantation patients were divided into sepsis group（HSS group,n=9） and non-sepsis group（HSNS group,n=10） according to whether the patient developed sepsis or not early after operation（within 14 days）.The level of serum inflammatory cytokine was detected at 30 min pre-transplantion and on 1 d,3 d,7 d,14 d post-transplantion.Their change and difference were compared between the two groups.Results The mean time for diagnosis of sepsis was 6 days.Compared with those before transplantation,post-transplant tumor necrosis factor（TNF）-α and interleulin（IL）-10 decreased after a slight increase on post-op day 1（P〈0.05）.Then they kept low in HSNS group,while TNF-α increased again on post-op day 7 in HSS group.High mobility group box 1 protein（HMGB1） messenger ribonucleic acid（mRNA） expression in HSNS group was elevated post transplantion and reached to its peak on day 3.Then it began to decrease and came down to the level of that pre-transplantion.HMGB1 mRNA expression in HSS group was elevated significantly post transplantion and maintained at high level.Its expression was significantly higher than that of HSNS group all the time（all in P〈0.05）.Conclusions In liver transplant patients with early sepsis,TNF-αelevated at the same as sepsis occurred.IL-10 increased later than TNF-α,but neither of them increased persistently during sepsis.HMGB1 increases before sepsis ocurred and maintained at high level.Dynamic mornitoring of HMGB1 expression may help to predict the development of early sepsis after liver transplantation.

关 键 词：肝移植 脓毒血症 高迁移率族蛋白B1 炎症因子 

分 类 号：R617[医药卫生—外科学]