甲泼尼龙对心肺复苏后患者血清细胞因子的影响

Effects of methylprednisolone on cytokines in patients after successful cardiopulmonary resuscitation

目的探讨甲泼尼龙对心肺复苏后患者血清细胞因子表达的影响。方法将2005年5月至2007年5月上海市闸北区中心医院心肺复苏恢复自主循环（ROSC）30例患者，经心电监护或心电图证实院内心跳呼吸骤停，即刻心肺复苏恢复自主循环、生存≥48h、年龄≥18岁患者；入选病例排除因各种疾病终末期、晚期肿瘤、自然死亡因素所致心跳呼吸停止者，及发病前一周内伴有各种感染、休克、严重创伤者。随机分为A组（甲泼尼龙组，n=14）；复苏后加用甲泼尼龙每日3mg／kg，分两次静脉滴注，连续3d；B组（对照组，n=16）；采用常规心肺复苏治疗。两组患者原发病因基本相仿。ELISA法检测两组心肺复苏即刻、ROSC后24h、48h、72h、7d的血清肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）水平。资料数据采用SPSS11．5版统计软件进行分析处理，计量资料以均数±标准差（-↑x±s）表示，两组各不同时间点计量资料两两比较采用成组t检验，两组心肺复苏后SIRS患病率和病死率采用Chi-square test，以P〈0．05为差异有统计学意义。结果两组心跳骤停至心肺复苏恢复自主循环平均间期[（8．9±4．6）min，（9．6±5．0）min]及心肺复苏即刻血清TNF-α、IL-1β、IL-6、1L8、IL-10水平差异无统计学意义（P〉0．05）。与B组比较，A组ROSC后24h、48h血清TNF-α、IL-1β、IL-6、IL-8水平明显降低（P〈0．05—0．01），ROSC后72hA组血清IL-8水平（114．33±149．72）仍低于B组（332．09±277．45）（P〈0．05），ROSC后7d两组血清各细胞因子水平差异无统计学意义（P〉0．05）。血清IL-10水平两组在不同时间点差异均无统计学意义（P〉0．05）。结论早期应用甲泼尼龙可降低心肺复苏后患者血清TNF-α、IL-1β、IL-6、IL-8释放，对复苏患者有保护作用。

Objective To investigate the effects of methylprednisolone on the release of cytokines in patients after successful cardiopulmonary resuscitation （CPR）. Method Thirty patients after CPR with restoration of spontaneous circulation （ROSC） were randomly divided into two groups： group A （methylprednisolone group, n = 14） and group B （control group, n = 16） during the period from May 2005 through May 2007.The patients of group were treated with methylprednisolone 3 mg/kg by intravenously twice a day after ROSC. The levels of serum tumor necrosis factor-α（TNF-α）, interleukin-1β（ IL-1β）, interleukin-6（IL-6）, interlenkin-8（ IL-8）, interleukin-10 （IL-10） were measured by enzyme-linked immunosorbent assay （ELISA）before CPR,and 24, 48, 72 hours and 7 days after ROSC.The data were analyzed studentis t test and chi-gquare test. A P value less than 0.05 indicated significant difference. Results There was on significant difference in the mean time from cardiac arrest to return of spontaneous circulation, and the levels of serum cytokines between the two groups before CPR （ P 〉 0.05）. In comparison with group B, the levels of serum TNF-α, IL-1β, IL-6, IL-8 decreased markedly at 24 and 48 hour after ROSC in group A （ P 〈 0.05 - 0.01）, and the levels of serum IL-8 decreased markedly at 72 hours after ROSC in group A （ P 〈 0.05）.The levels of serum TNF-α,IL-1β, IL-6, IL-8 were not of significant differences between the two groups at 7 days after ROSC （ P 〉 0.05）. There was no significant difference in the levels of serum IL-10 between the two groups at different time points after ROSC （ P 〉 0.05）. Conclusions Methylprednisolone plays a role of preventive effects on patients with ROSC after PCR through decreasing the levels of serum TNF-α,IL-1β, IL-6, IL-8.