心脏直视手术中糖皮质激素对血浆细胞因子的影响  

CORTICOSTEROIDS AND PROINFLAMMATORY CYTOKINES IN PATIENTS UNDERGOING HYPOTHERMIC CARDIOPULMONARY BYPASS

作　　者：石践[1] 陆学东[2] 邵展社[1] 李学文[1] 高宏[1] 马良龙[1] 王宗超[1] 

机构地区：[1]陕西省人民医院心脏外科,西安710068 [2]陕西省人民医院病毒研究室,西安710068

出　　处：《中国现代医学杂志》2003年第15期10-12,共3页China Journal of Modern Medicine

基　　金：陕西省卫生厅青年科研基金;98-16

摘　　要：目的 :观察低温体外循环心内直视手术中细胞因子IL - 8、TNF -a、IL - 10的变化 ,探讨皮质类固醇激素的使用对其影响。方法 :在 6 0例体外循环手术的患者中 ,随机分为甲基强的松龙组、地塞米松组、对照组。应用ELISA法测定围体外循环期各组中血浆IL - 8、TNF -α、IL - 10浓度。结果 :对照组中IL - 8在体外循环结束后明显高于体外循环前 (P <0 .0 1) ;两治疗组中IL - 8较手术前升高 ,但不明显 (P >0 .0 5 )。治疗组中IL - 10在体外循环后其血浆浓度均增加 (P <0 .0 1) ,两组中无显著差异 ;对照组中IL - 10浓度较手术前升高(P <0 .0 5 ) ,但其升高幅度不如两治疗组明显。三组中TNF -a均无明显变化。结论 :皮质类固醇激素的使用可以显著增加体外循环后IL - 10的血浆内含量 ,减少IL - 8的生成 ;但对TNF -a无影响。Objective:To determine the variety of proinflammatory cytokines ,such as tumor-necrosis-factor alpha (TNF-a),Interleukin-8 (IL-8),and antiinflammatory cytokine interleukin-10 (IL-10)under conditions of hypothermic cardiopulmonary bypass(CPB) with or without the use of corticosteroids. Methods:Randomly ,sixty patients,who underwent cardiac procedure in our institute, were equally divided into three groups:group A ( control ,normal saline 50 ml),group B(Dexamethasone , DXM, 1mg/kg),group C (methelprednisolone,MPS,30mg/kg).Plasma levels of TNF-a, lL-8,and IL-10 were measured in peripheral arterial blood before anesthesia (t0) , aortic cannulation (t1) , 5 minutes after CPB (t2) , 10 minutes after aortic declamping (t3), and 4 hours after aortic declamping (t4).All the levels of these cytokines were measured by enzyme-linked immunosorbent assay. Results:Group A demonstrated significant increase in levels of IL-8 at t3 and t4 when results were compared with those of the same group baseline ( P <0.01) and with those of group B and C at t3 and t4 .No significant changes were noted between group B and C at any time .Group B and C demonstrated a significant increase in levels of IL-10 at t3 and t4 compared with the baseline and with group A at the same time( P <0.01).No significant diferences were noted between group B and C at any time. Levels of TNF-a were not changed significantly at all the three groups at any time.Conclusions: Our data suggested that CPB did cause an increase of IL-8 and IL-10,but not tumor-necrosis-factor alpha .The pretreatment of DXM or MPS has a similar antiinflammatory effect in blunting cardiopulmonary bypass-induced systemic IL-8 release and in increasing IL-10 release.

关 键 词：体外循环 皮质类固醇激素 IL-8 TNF-A IL-10 

分 类 号：R654.2[医药卫生—外科学]