抑肽酶对体外循环围术期白介素-2 分泌细胞和可溶性受体表达的影响

Effects of Aprotinin on Interleukin 2 Secreting Cell and Soluble Interleukin 2 Receptor During Cardiopulmonary Bypass

目的：白介素和其受体介导的反应在免疫功能中有重要地位，我们着重观察白介素－２分泌细胞（ＩＬ－２Ｃ）和可溶性白介素－２受体（ｓＩＬ－２Ｒ）在体外循环（ＣＰＢ）中和术后的变化，以及抑肽酶对其影响。方法：２１例瓣膜替换手术患者分两组，对照组（１０例），抑肽酶组（１１例），体外循环中给２００万单位抑肽酶。结果：两组ＩＬ－２Ｃ在体外循环１０分钟时明显降低，３０分钟时明显增加，６０分钟时继续增加，术后达到高峰，术后１天和术后３天明显低于术前。ＩＬ－２Ｃ和库血应用呈负相关。两组ｓＩＬ－２Ｒ变化基本和ＩＬ－２Ｃ相似。但抑肽酶组在体外循环６０分钟时、术后即刻、术后１天、术后３天ｓＩＬ－２Ｒ的增加幅度低于对照组。抑肽酶组术后胸腔引流量明显低于对照组。结论：体外循环对ＩＬ－２Ｃ开始为刺激，术后转为抑制状态。ｓＩＬ－２Ｒ在体外循环后期和术后增加，这对免疫功能有不利影响，抑肽酶除改善凝血功能外，还可能改善白介素介导的免疫反应。

Objective:Interleukin 2 and its receptor mediated action is important in immunity mechanism.We observed the changes of interleukin 2 secreting cell(IL 2C)and soluble interleukin 2 receptor (sIL 2R)during cardiopulmonary bypass(CPB)and effects of aprotinin on them. Methods:Twenty one patients undergoing valve replacement were divided into two groups,control group( n =10)and aprotinin group( n =11,2 000 000 unit aprotinin were given during CPB).Blood samples were collected before,at 10,30,60 min during,and right after CPB and also on the 1st and 3rd day after operation for IL 2C and sIL 2R determination. Results:As compared to pre CPB,the IL 2C content was lowered at 10 min but increased at 30 and 60 min during CPB,then up to the peak right after CPB,but decreased on the 1st and 3rd day after operation in both groups(all p <0 05),while the amount of SIL 2R was decreased first at 10 min and then increased continuously and remained at high level (all p <0 05),but the increment was less in aprotinin group than in the control ( p <0 05)at 60 min during CPB and afterwards.Furthermore,the chest drainage was significantly lower in aprotinin group( p <0 05). Conclusion:The immunity depression in post CPB is associated with low level of IL 2C and high level of sIL 2R,aprotinin can ameliorate this situation.