体外循环患者血浆致炎因子、抗炎因子、内毒素的变化及其临床意义

摘要

目的观察体外循环心脏手术患者血浆致炎因子(肿瘤坏死因子,白介素6)、抗炎因子(白介素4,白介素10)及内毒素的变化.探讨致炎因子与抗炎因子在体外循环炎症反应中的作用.方法采用鲎试剂,ELISA等技术分别观察体外循环和未进行体外循环的患者血浆内毒素、TNF-α、IL-6、IL-4、IL-10的水平.结果体外循环时发生内毒素血症;体外循环时血浆TNF-α、IL-6、IL-4、IL-10水平显著升高,但抗炎因子IL-4,1L-10释放迟于致炎因子TNF-α,IL-6.结论体外循环时,血浆抗炎症介质的释放要迟于致炎症介质,抗炎症介质释放的延迟可能是导致炎症反应抗炎症反应失衡的原因,这可能与体外循环时全身炎症反应的发生有一定关系.%Objective:To explore the changes of plasma inflammatory cytokine, anti - inflammatory cytokine and endotoxin levels in patients with Cardiopulmonary bypass, and further more, to analyse their roles in the development of systemic inflammation response. Methods: Sixteen patients with rheumatic heart disease(8 cases with cardiopulmonary bypass,8 case without cardiopulmonary bypass)were selected for this study. Limulus amebocyte lysate chromogenic assay and ELISA were used to determine the changes of endotoxin, TNF - α, IL - 6, IL - 4 and IL -10 levels in plasma. Results: Plasma TNF-α , IL- 6, IL- 4 and IL- 10 levels in patients with cardiopulmonary bypass were significantly higher than those in patients without cardiopulmonary bypass. The release of anti - inflammatory mediator( IL- 4, IL- 10) was shown to be later than that of inflammatory mediators(TNF- α , IL- 6). Plasma endotoxin levels in patients with cardiopulmonary bypass were significantly higher than those in patients without cardiopulmonary bypass. Conclusions:The releaseof anti- inflammatory mediators was showns to be later than that of inflan matory mediators. The unbalance between them may contribute to the immune dysfunction and lead to systemic inflammation response in patients with cardiopulmonary bypass.