体外膜肺氧合中犬肿瘤坏死因子、白介素8及白介素10的变化

The changes of IL-8、TNF-α and IL-10 in doge during extracorporeal membrane oxygenation

目的:探讨细胞因子肿瘤坏死因子α(TNF-α)、白介素8(IL-8)及白介素10(IL-10)在体外膜肺氧合(ECMO)过程中的变化特点及变化规律。方法:选择健康杂种犬6只,均为雄性,体质量(23±2)kg,采用Medtronic 550型离心泵;ECMO儿童套包:Medtronic Silicone。沿腹股沟方向切开皮肤并解剖出股静脉,分别插入12Fr动脉插管及14Fr静脉插管并结扎固定动静脉插管与ECMO循环管道连接。ECMO转流前5min静脉注射肝素1mg/kg,检测ACT,维持在180～220s。分别在ECMO治疗开始前30min,开始后6h、12h、24h、36h及48h抽取犬外周静脉血,分离出血清,采用酶联免疫吸附法(ELISA)检测血清炎性细胞因子TNF-α、IL-8及IL-10,观察TNF-α、IL-8及IL-10在ECMO过程中不同时间点的变化特点和变化规律。结果:在ECMO过程中随着辅助时间的延长外周血TNF-α浓度和IL-8浓度有升高的趋势,但在实验开始36h外周血中TNF-α、IL-8浓度差异均无统计学意义(P>0.05),在辅助48h时与辅助前差异有统计学意义(P<0.05)。IL-10浓度在ECMO辅助过程中无明显的变化,ECMO辅助前和辅助过程中的各时间点比较IL-10浓度差异均无统计学意义(P>0.05)。结论:体外膜肺氧合治疗36h不会引起血清炎症及抗炎因子显著升高,48h开始血清炎症因子浓度开始升高,抗炎因子浓度仍无明显变化。

Objective：To investigate the changes of inflammatory cytokine interleukin-8（IL-8）,tumor necrosis factor-α（TNF-α） and anti-inflammatory cytokine interleukin-10（IL-10） in systemic inflammatory response syndrome in extracorporeal membrane oxygenation（ECMO）.Methods：6 healthy mongrel male dogs were Choice,weight（23 ± 2） kg,Medtronic 550 centrifugal pump and Medtronic Silicone membrane oxygenator were used.To cut open the skin and to dissect femoral artery and femoral vein along fold inguinal,then to insert arterial cannula and venous cannula,the cannula type was 12Fr and 14Fr respectively,meanwhile to fix cannula and to link ECMO circulation tubing.Before 5min of ECMO begin to work,intravenous injection heparin 1 mg/kg,to detect activated coagulation time（ACT） to keep ACT at 220-250 s.The sampling time were collected from peripheral vein at the moment before the extracorporeal membrane oxygenation began and after ECMO starting 6th hour、12th hour、24th hour、36th hour and 48th hour.Inflammatory cytokine interleukin-8（IL-8）,interleukin-10（IL-10） and tumor necrosis factor-α（TNF-α） were measured by enzyme-linked immunosorbent assays（ELISA）.To observe the change characteristic and change regularity of IL-8,TNF-α and IL10 during ECMO.Results：There was no significant increase of TNF-α,IL-8,IL-10 serum level at 6,12,24,36 hours after ECMO begin compared with the serum level before ECMO（P 0.05）.Serum inflammatory cytokine TNF-α,IL-8 and increased significantly after 48 hours in every experiment animal（P 0.05）.There wasn＇t significant increase of IL-10 serum level during 48 hours after ECMO begin compared with the serum level before ECMO（P 0.05）.Conclusion：ECMO can not significantly increase the serum inflammatory cytokine or anti-inflammatory cytokine after 36 hours therapy.After 48 hours,ECMO can significantly increase the serum inflammatory cytokine,but can＇t increase anti-inflammatory cytokine.