IL-6,TNF-α,CRP,cortisol在围手术期监测中的意义

The clinic significance of IL-6, TNF-α, CRP and cortisol after major surgery

目的 探讨IL - 6,TNF -α ,CRP ,cortisol在围手术期监测中的作用。方法 Ⅱ ,Ⅲ期胃癌 (A组 )、低位直肠癌 (B组 )各 13例和食管贲门癌 (C组 ) 11例 ,均接受根治性切除术 ,对照组 ( 10例 )为择期小手术。所有患者于术前 1d、术后 2h、术后 1,6d取血 ,测定血浆IL - 6,INF -α ,CRP ,cortisil含量 ,以及体外内毒素 (LPS)刺激全血释放TNF -α含量的变化。结果 ①A ,B ,C 3组患者术后 2hIL - 6含量显著升高 (P <0 0 5 ) ,术后 1d则明显回落 ,出现并发症患者IL - 6呈过度升高 ;②术后 1d 3组CRP含量显著高于对照组 (P <0 0 5 ) ;③各组手术前后TNF -α无显著改变 (P >0 0 5 ) ;全血受LPS刺激后 ,3组术后 2hTNF -α释放量较其他时点及对照组显著降低 (P <0 0 5 ) ;④A ,C组术后 2hcortisol显著升高 (P <0 0 5 )。结论 监测术后血浆IL - 6,CRP ,cortisol含量及LPS刺激全血TNF -α释放量的变化有利于创伤程度和预后的判断 。

Objective To investigate the clinical significance of changes in plasma IL-6, TNF-α, CRP and cortisol level and TNF-α production in vitro during perioperative period. Methods 13 cases of gastric carcinoma (group A), 13 of rectal carcinoma (group B) and 11 of esoghageal or cardial carcinoma (group C) who received radical resection were eligible for the study. 10 patients receiving elective minor operation were used as controls. Plasma IL-6, TNF-α, CRP, cortisol and endotoxin-stimulated TNF-α production by whole blood in vitro were measured before and at 2 h, 1 day and 6 days after operation.Results ①IL-6 level at 2 h after operation in patients of A,B, and C groups was significantly higher than that before surgery or that in controls ( P <0 05).②CRP level at 1 day after operation in patients of A, B, and C groups was significantly higher than that in controls ( P <0 05).③No significant change in TNF-α level was found in all patients throughout periopertive period. LPS-stimulated increments of TNF-α production at 2 h postoperatively in A, B and C groups reduced significantly compared to other time points and the controls ( P <0 05).④Cortisol level at 2 h postoperatively in A and C groups was significantly higher than that before surgery and in controls ( P <0 05).Conclusion Monitoring plasma IL-6, CRP, cortisol level, and the increment of TNF-α product by LPS-stimulated whole blood during perioperative period may help to evaluate the severity of stress and prognosis.