先天性心脏病患者体外循环术后血IL-6及ICAM-1的变化

Changes of levels of plasma interleukin-6 and intercellular adhesion molecule-1 in patients with congenital heart disease after cardiopulmonary bypass surgery

目的 :探讨先天性心脏病 (CHD)患者体外循环 (CPB)术后血浆白细胞介素 6 (IL- 6 )及细胞间粘附分子 - 1(ICAM- 1)的变化及其在 CPB术后全身炎性反应综合症 (SIRS)中的作用。方法 :以 2 5例非紫绀型 CHD患者 CPB下手术者为研究对象 (试验组 ) ,10例未作 CPB的心血管手术者作对照 (对照组 ) ,酶免法测定手术前、后多时间点外周动脉血中 IL - 6及 ICAM- 1水平 ,同时测定血中性粒细胞数 ,记录体温。结果 :(1)两组术后 IL - 6水平较术前均明显增高 (P<0 .0 1) ,但术后各时点的 IL- 6水平 ,试验组的比对照组升高明显 (P<0 .0 1) ;(2 )术后两组 ICAM-1与术前相比无显著差异 (P>0 .0 5 ) ;(3)术后两组中性粒细胞水平和体温均升高 (P<0 .0 5 ) ,但试验组升高更明显 (P<0 .0 5 )。结论 :(1)除手术应激外 ,CPB本身可导致 IL - 6释放增加 ;(2 )作为炎性介质 ,IL - 6可能参与 CPB后 SIRS的发生 ;(3)单一 ICAM- 1在 CPB心脏手术后 SIRS中可能不占重要地位。

Objective:To investigate the changes of levels of plasma interleudin-6(IL-6) and intercellular adhesion molecule-1(ICAM-1) after cardiopulmonary bypass(CPB) surgery in patients with congenital heart disease(CHD) and their role in the pathogenesis of systemic inflammatory response syndrome(SIRS) after CPB.Methods:Twenty-five noncyanotic CHD patients underwent heart surgery with CPB (study group) and 10 patients underwent closure surgery of patent ductus arteriosus without CPB(control group). Arterial blood samples were taken after induction of anesthesia(baseline), at the end of the operation, 2 and 5 hours after operation, and on the first postoperative day.Plasma levels of IL-6 and ICAM-1 were determined by enzyme-linked immunosorbent assays(ELISA), neutrophil count and temperature were taken meanwhile.Results:(1)As compared with baseline,IL-6 levels increased markedly in both groups at multiple time points postoperative (P<0.01), it was higher in study group than that in control group(P<0.01);(2)ICAM-1 levels were almost unchanged in each group postoperative(P>0.05);(3)Neutrophil count and temperature were significantly elevated in both groups(P<0.05) after the operation, but it was higher in study group.Conclusion:(1)In addition to surgical stress, CPB itself can result in obvious IL-6 release;(2)As an inflammatory mediator,IL-6 may be role in pathogeneses of SIRS after CPB;(3)ICAM-1 alone may not be so important in CPB related inflammatory response.