乌司他丁对肝癌切除术患者炎症反应的影响

Effect of ulinastatin on inflammatory response in patients undergoing resection of liver cancer

目的观察乌司他丁在肝癌切除术中的抗炎效应。方法将美国麻醉医师协会体格情况分级Ⅰ～Ⅱ级行肝癌切除术的40例患者按随机数字表法分为乌司他丁组和生理盐水组,每组20例。实施静脉吸入复合全身麻醉诱导插管后,乌司他丁组以乌司他丁10 000 U.kg-1溶于20 mL生理盐水中,生理盐水组给予等量的生理盐水,于切皮即刻20 min内经外周静脉持续恒速泵入。分别于术前(T1)、术后(T2)、术后6 h(T3)、术后24 h(T4)抽取中心静脉血,分离血清后采用LiquiChip液相蛋白芯片系统检测血清细胞因子白细胞介素(IL)-6、IL-8、IL-10和肿瘤坏死因子-α(TNF-α)水平。结果组间比较显示,2组T1时IL-6、IL-8、IL-10及TNF-α比较差异均无统计学意义(P>0.05);2组间同一时间的IL-8、TNF-α水平差异均无统计学意义(P>0.05);T2、T3、T4时乌司他丁组的IL-6水平低于生理盐水组(P<0.05),IL-10水平高于生理盐水组(P<0.01),差异均有统计学意义。组内比较显示,2组各时点之间TNF-α水平差异均无统计学意义(P>0.05);T2、T3、T4时乌司他丁组和生理盐水组的IL-6、IL-8、IL-10水平均高于T1时点,差异有统计学意义(P<0.01);且IL-6、IL-8水平均随时间推移而升高,差异有统计学意义(P<0.05);而T2、T3、T4时点之间IL-10水平差异无统计学意义(P>0.05)。结论肝癌切除术中存在炎症反应,乌司他丁可抑制血清促炎因子的生成,同时可促进抗炎因子的产生。

Objective To study the anti-inflammatory effect of ulinastatin in patients undergoing resection of liver cancer.Methods Forty adult patients of American Society of Anesthesiologists classⅠ-Ⅱ who were scheduled for resection of liver cancer were divided into two groups according to random digits table,including ulinastatin group and normal saline group and twenty patients in each group.After general anaesthesia,the patients in ulinastatin group were treated with ulinastatin 10 000 U·kg-1 dissolved in 20 mL normal saline,while the patients in normal saline group were treated with 20 mL normal saline,intravenous drip infusion,within 20 minutes after the start of surgery.Before operation（T1）,after operation（T2）,6 hours（T3） and 24 hours（T4） after operation,the venous blood samples were taken from internal jugular vein.After separation of the serum,the levels of interleukin（IL）-6,IL-8,IL-10 and tumor necrosis factor-α（TNF-α） were detected with LiquiChip system.Results There was no statistically significant difference in the levels of serum IL-6,IL-8,IL-10 and TNF-α at T1 between the two groups（P0.05）.There was no significant difference in the levels of serum IL-8 and TNF-α at the same time point between the two groups（P0.05）.Compared with normal saline group,at T2,T3 and T4,the level of IL-6 was lower in ulinastatin group（P0.05）,but the level of IL-10 was higher significantly（P0.01）.There was no significant difference in serum TNF-α level among all time points between the two groups（P0.05）.The levels of IL-6,IL-8 and IL-10 in the two groups at T2,T3 and T4 were higher than those at T1（P0.01）,and the levels of IL-6 and IL-8 increased with the development of time（P0.05）.However,there was no significant difference in IL-10 values among T2,T3 and T4 in the two groups（P0.05）.Conclusion Inflammatory response exist in patients undergoing resection of liver cancer.Ulinastatin can inhibit the generation of pro-inflammatory cytokines in serum,while promoting the production of anti-inflammatory factors.