儿童体外循环围术期支气管肺泡灌洗液中IL-8的变化及意义

Variations and Significance of IL-8 in the Bronchoalveolar Lavage Fluid in the Perioperative Period of Cardiopulmonary Bypass Operation on Children

目的探讨体外循环和肺动脉高压对肺局部IL-8的影响。为临床诊疗寻找监测气道高反应的有价值的分子生物学指标。方法对34例心脏直视手术，20例普胸部手术患儿分别于麻醉插管后手术前、手术后2—3h、手术后24h共3个时点采集肺泡灌洗液，采用双抗体夹心酶联免疫吸附（ELISA）法检测患儿IL8的变化。结果术前IL-8体外循环组和非体外循环组无差异，但术后2～3h、24h体外循环组高于非体外循环组；各时点IL-8水本肺高压组均高于无肺高压组。同时肺动脉高压患儿术后出现气道高反应的比例（6／9）高于其他无肺动脉高压患儿（5／25）。结论体外循环使肺泡灌洗液IL-8水平升高，可能与体外循环术后的气道反应性增高有关；合并肺动脉高压的左向右分流患者IL-8水平高于无肺动脉高压组，术后容易出现呼吸道并发症，易致高反应发生。

Objective To understand the influence of cardiopulmonary bypass （CPB） and pulmonary hypertension （PH） on IL-8 in lung, and find valuable and sensitive molecular biomarkers for monitoring airway hyperresponsiveness （AHR） in clinical diagnosis and treatment. Methods The bronehoalveolar lavage fluid （BLAF） samples were taken at three different time points （preoperative, 2-3 and 24 hours postoperative respectively） from CPB group （34 eases） and Non-CPB group （20 eases）. The expressions of IL-8 in the two groups were measured by sandwich enzyme-linked immunosorbent assay （ELISA）. Results There was no difference between the two groups on preoperative expression of IL-8, while 2-3 and 24 hours postoperative expressions of IL-8 in CPB group were significantly higher than those in Non-CPB group. The expressions of IL-8 in PH group （9 eases） were higher than those in Non-PH group （25 eases） at all three time points, and the ratio of postoperative AHR in children with PH （6/9） was higher than that without PH （5/25）. Conclusions The ascent of IL-8 level in BLAF caused by CPB may be associated with increasing airway responsiveness after CPB. PH patients combine with the left-to-right shunt, of which IL-8 levels are higher than those without PH, are subject to pulmonary complications and AHR.