体外循环围术期cTnT及炎症相关细胞因子的动态监测

Clinical value of dynamic determination of serum cTnT and cytokines during perioperation of cardiopulmonary bypass surgery

目的:动态监测体外循环(CPB)下心脏手术围术期患者血清心肌肌钙蛋白T(cTnT)及炎症相关细胞因子的变化,探究其临床价值。方法:18例行CPB心脏手术患者(CPB组)和15例非CPB心脏手术患者(对照组),分别采集其术前,术后即刻,24 h,48 h和72 h 5个时间点的外周血标本,测定血清cTnT、促炎细胞因子(TNF-α,IL-6,IL-8)和抗炎细胞因子(IL-2,IL-10)的水平,对结果比较、分析。结果:CPB组术后即刻,24 h,48 h的cTnT与术前比较显著增高,差异有统计学意义(P<0.01),之后趋于术前正常水平;血清TNF-α于术后即刻、术后24 h显著增加,且在术后即刻达到峰值,于术后48 h恢复至术前水平;IL-6水平于术后24 h出现高峰,之后逐渐下降;血清IL-8水平升高趋势持续到术后72h,在术后24 h达到峰值;血清IL-2水平在术后即刻显著增加,之后基本恢复至术前水平;血清IL-10水平在术后即刻,24h,48 h均显著升高,且术后24 h达到峰值,至术后72 h恢复到术前水平。结论:CPB围术期动态监测cTnT、促炎及抗炎细胞因子的水平变化,对CPB术后患者的监护与临床预后有指导意义。

Objective： Dynamic monitoring cardiopulmonary bypass （ CPB）, perioperative cardiac surgery patients with serum cardiac troponin T（cTnT） and cytokines changes, explore their clinical value. Methods： Eighteen routine CPB heart surgery patients （CPB） and 15 cases of non-CPB heart surgery patients （control group） were collected their preoperative and postoperative immediately, 24 h, 48 h and 72 h five time points of peripheral blood samples for determination of serum cTnT, the pro-inflammatory cytokines （TNF-a, IL-6, IL-8） and anti-inflammatory cytokines（IL-2, IL-10） levels, and the results of comparison, analysis. Restilts： Immediately after CPB, after 24 h and 48 h when compared with the preoperative cTnT were signifi-cantly higher, the difference was significant（P 〈0.01 ）, then was as the normal preoperative level. The level of serum TNF-a significally increased immediately and after operation 24 h and reached its peak at the immediate postoperative, and after 48 h returned to the preoperative level ; The level of IL-6 levels after 24 h at the peak, then decreased gradually; serum IL-8 level rose trend to continue until 72 h and in the 24 h reached its peak; serum IL-2 levels were significantly increased immediately and then returded to preoperative level ;The level of serum IL-10 during the immediate postoperative, 24 h and 48 h after were significantly increased, its peak was at 24 h after and 72 h retumed to preoperative levels. Conclusion：Perioperative CPB dynamic monitoring cTnT, the pro-inflammatory and anti-inflammatory cytokines level changes in the monitor of CPB patients had clinical prognosis significance.