阿芬太尼预处理对下肢缺血再灌注患者外周血白细胞介素-6、白细胞介素-10及其mRNA表达的影响

Effects of Alfentanil preconditioning on interleukin-6,interleukin-10 and expression of their mRNA in patients undergoing lower limber ischemia reperfusion injury

目的观察阿芬太尼预处理对下肢缺血再灌注患者外周血白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及其mRNA表达的影响。方法选取2011年1～7月在青岛市市立医院硬膜外麻醉下使用止血带的单侧下肢择期手术患者24例,随机分为两组:阿芬太尼组(A组)和对照组(C组),每组12例。上止血带前5 min A组患者缓慢静注阿芬太尼10μg/kg+生理盐水5 mL;C组患者给予5 mL生理盐水。分别于上止血带前(T1)、松止血带后30 min(T2)、4 h(T3)取静脉血检测细胞因子IL-6和IL-10的mRNA表达及其血浆浓度。结果于T1时A组和C组IL-6[(21.1±3.9)ng/L比(20.8±3.6)ng/L]、IL-10[(30.9±5.3)ng/L比(31.6±4.9)ng/L]浓度、IL-6/IL-10比值[(0.67±0.16)比(0.66±0.15)]及IL-6 mRNA/IL-10 mRNA比值[(1.98±0.47)比(1.94±0.50)]相比T2～3明显升高(P<0.05)。T2～3时,与C组比较,A组IL-6血浆浓度[(27.9±4.8)、(29.6±5.2)ng/L]、mRNA[(1.05±0.17)、(1.36±0.25)]、IL-6/IL-10[(0.71±0.12)、(0.73±0.15)]及IL-6 mRNA/IL-10 mRNA[(2.03±0.42)、(2.32±0.49)]比值明显低于C组(P<0.05)。结论术前应用小剂量阿芬太尼预处理用于下肢缺血再灌注患者可有效抑制促炎性细胞因子生成,有益于维持促炎性细胞因子/抗炎性细胞因子相对平衡。

Objective To investigate the effects of Alfentanil preconditioning on interleukin-6（IL-6）,interleukin-10（IL-10） and expression of their mRNA in patients undergoing lower limber ischemia reperfusion injury.Methods 24 patients undergoing operation of single lower limber with tourniquet in Qingdao Municipal Hospital from January 2011 to July 2011 were randomly divided into two groups： Alfentanil group（group A） and control group（group C）,with 12 cases in each group.Patients in group A were infused slowly Alfentanil 10 μg/kg and normal saline 5 mL before tourniquet inflation,and patients in group C received normal saline 5 mL.Blood sample were taken before tourniquet inflation（T1）,30 min（T2）,4 h（T3） after tourniquet deflation for determination of plasma IL-6,IL-10 concentration and expression of their mRNA.Results Compared with T1,IL-6 [（21.1 ±3.9） ng/L vs（20.8±3.6） ng/L],IL-10 [（30.9 ±5.3） ng/L vs（31.6±4.9） ng/L] level,IL-6/IL-10 [（0.67 ±0.16） vs（0.66±0.15）] ratio and IL-6 mRNA/IL-10 mRNA [（1.98 ± 0.47） vs（1.94±0.50）] ratio were higher significantly at T2～3 in group A and C（P〈0.05）.IL-6 level [（27.9±4.8）,（29.6± 5.2） ng/L] and expression of its mRNA [（1.05±0.17）,（1.36±0.25）],IL-6/IL-10 [（0.71±0.12）,（0.73±0.15）] ratio and IL-6 mRNA/IL-10 mRNA [（2.03±0.42）,（2.32±0.49）] ratio were lower at T2～3 in group A than those in group C（P〈0.05）.Conclusion Small dose Alfentanil preconditioning is effective in inhibiting production of pro-inflammatory cytokines and maintaining a balance between pro-inflammatory and anti-inflammatory cytokines.