L-精氨酸对体外循环后细胞因子的影响

Effects of L-Arginine on Cytokines after Cardiac Surgery with Cardiopulmonary Bypass.

目的 探讨 L-精氨酸 (L- arginine)对体外循环 (CPB)缺血 -再灌注损伤后全身炎症反应的抑制作用。方法 术前将 5 1例拟行心瓣膜置换术的风湿性心脏病患者随机分成两组 :L-精氨酸组 (n=2 5 ) ,术中给予 30 0 mg/kgL -精氨酸治疗 ;对照组 (n=2 6 ) ,术中给予等量的 5 %葡萄糖注射液。分别于术前、CPB后 2 h、4 h、8h、2 4 h和 4 8h采取动脉血 ,用酶联免疫吸附法分别测定血浆肿瘤坏死因子 - α(TNF- α)、白细胞介素 - 1β(IL- 1β)、白细胞介素 - 10 (IL- 10 )的浓度。 结果 两组 TNF-α、IL - 1β和 IL - 10水平于 CPB后均升高 (P<0 .0 5 ) ,TNF-α和 IL - 1β于 CPB后 4 8h恢复至基础值 ;L-精氨酸组 CPB后 4 h、8h、2 4 h TNF- α和 IL- 1β升高幅度明显低于对照组 (P<0 .0 5 ) ;IL- 10水平各时点组间比较差别无统计学意义 (P>0 .0 5 )。 结论 L-精氨酸可以降低 CPB后 TNF- α、IL- 1β的血浆水平 ,具有抑制 CPB缺血 -再灌注损伤后全身炎症反应的作用。

Objective To investigate the inhibitory effects of L- arginine （L-arg） on systemic inflammatory response after cardiopulmonary bypass（CPB）. Methods Fifty-one patients with rheumatic heart disease were randomly divided into two groups：L- arg group （n=25） and control group （n=26）. For L-arg group, L-arg at 300mg/kg was given during opt.ration. Plasma levels of tumor necrosis factor-α（TNF-a）,interleukin-1β（IL-1β）and interieukin-10（IL-10） were measured by enzyme-linked immunosorbent assay technique at baseline（before operation） and at 2,4,8,24 and 48 h after CPB termination. Results TNF α,IL- 1βand IL-10 levels were increased in both groups after CPB （P〈0.05） ; levels of TNF a, IL-α returned to normal at 48 h after CPB; In L-arg group, TNF-α and IL-1β levels were significantly lower than those in control group at 4,8 and 24 h after CPB （P〈0.05）. No significant difference were detected in IL- 10 between groups（P〉0.05）. Conclusion L-arg may decrease plasma levels of TNF α and IL -1β after CPB, it implies L-arg may inhibit inflammation induced by CPB.