围腹部手术期非肿瘤患者血清sIL-2R TNF-α动态变化与术后免疫功能

Dynamic changes of serum sIL-2R TNF-α during the perioperation of nontumorous abdominal case and their relations with postoperative immunologic manifestation

目的 探讨非肿瘤性腹部手术患者围手术期血清TNF-α,sIL-2R的动态变化与术后免疫功能变化之关系。方法 以ELISA法检测患者术前、术后24h、术后1周的血清TNF-α和sIL-2R。结果 多因素分析显示:二者水平均与腹腔重度感染有关(sIL-2R:P<0.001,TNF-α:P<0.001);与手术创伤和机体应激有关。其中术后24hsIL-2R水平升高超过450kU/L者,其术后继发感染和原发感染消退延迟的发生率有显著性增加。结论 依赖IL-2/mIL-2R、sIL-2R途径的免疫抑制,对围手术期抗菌(胞外和胞内感染)免疫功能有明显不利影响。这可能既是腹部原发性感染消退延迟或波动反复的原因之一,又是术后继发性感染机会增加的原因之一。

Objective To explore the relation between dynamic change of serum levels of TNF α,sIL 2R during perioperation and patient′s immunocompetence after operation.Method Serum TNF α and sIL 2R of 96 nontumorous abdominal patients were checked by ELISA 24 h pre and postoperations,and 1 week after the operation.Results Multiple factor analysis showed the serum level of both TNF α and sIL 2R is correlated with seriousness of the infection,operation wound and irritability.An increased serum concentration warns that the patients were liable to abdominal infection.Conclusion Inhibition of the immunoreactive passageway that relies on IL 2/mIL 2R、sIL 2R has an obvious harmful effect on the antibacterial (endocellular and exocellular infections) immunocompetence within perioperation.This may be a one of causes of both the postponed dissipation of primary infections and the increased incidence of secondary infections.