中性粒细胞黏附分子表达及细胞因子释放在体外循环炎性反应中的作用

Influence and Significance of Neutrophil Adhesion Molecules and Cytokines on Systemic Inflammatory Response to Extracorporeal Circulation

目的探讨中性粒细胞(PMN)黏附分子表达和细胞因子释放对体外循环(ECC)全身炎性反应的影响和意义。方法30例行ECC心脏直视手术患者分别于麻醉诱导后、ECC结束时、ECC结束后4h、ECC结束后8h、术后第1天晨5个时点采集静脉血。用全血细胞计数仪测定PMN数量,流式细胞仪测定PMN表面黏附分子CD11b表达水平,ELISA法测定血浆肿瘤坏死因子-α(TNF-α)、IL-6、IL-8水平。结果ECC前的PMN数量和其他时点间差别均有统计学意义(P<0.05);ECC前CD11b、TNF-α、IL-6、IL-8水平和ECC结束时、ECC结束后4h及ECC结束后8h间差别均有统计学意义(P<0.05),与术后第1天间差别无统计学意义(P>0.05)。结论ECC导致PMN数量增多,CD11b表达增高,细胞因子TNF-α、IL-6、IL-8释放增多,从而加剧炎性反应扩散和组织损伤。

Objective To investigate the influence and significance of polymorphonuclear neutrophil （PMN） adhesion molecules and cytokines on systemic inflammatory response to extracorporeat circulation （ECC）. Methods Thirty patients undergoing open heart surgery with ECC were studied. Venous blood samples were collected respectively after anesthesia induction, at the termination of ECC, at the 4th hour and 8th hour after ECC, and at five time points of next moring after operation. We determined the number of PMN with blood cell counter, expression of CD11b of PMN adhesion molecule with flow cytometer, and concentration of plasma tumor necrosis factor - α （ TNF - α）, interleukin - 6 （ IL - 6 ） and interleukin - 8 （ IL - 8 ） with enzyme - linked immunosorbent assays （ELISA）. Results The PMN counts, the expression of CD11b, the plasma levels of TNF - α, IL - 6 and IL - 8 were remarkerly increased during and after ECC （ P 〈 0. 05）. Conclusion ECC increases PMN number, up- regulates the expression of CDHb and increases releasing cytokines, thereby to intensify the extension of inflammatory reaction and tissue damage.