抑肽酶对小儿体外循环术后细胞因子的影响

The study on aprotinin blunt inflammation induced by Cardiopulmonary bypass in Children

目的 观察小儿体外循环术中、术后细胞因子肿瘤坏死因子 (TNF) α、白细胞介素 (IL) 6、IL 8的变化 ,评价抑肽酶对体外循环炎性反应的抑制作用。方法 19例在体外循环下行心内直视手术的先天性心脏病病儿 ,随机分为 2组。试验组 10例 ,于转机过程中加入抑肽酶 4～ 5万KIU kg;对照组 9例 ,未用抑肽酶。分别于麻醉后、升主动脉阻断后 10min、停机后 10min、停机后 2 4h共 4个时点采取动脉血。酶标免疫放射法分别测定IL 6、IL 8、TNF α。结果 对照组IL 6、IL 8、TNF α于体外循环开始后升高 ;IL 8、TNF α于术后 2 4h恢复至基础值。试验组TNF α各时间点升高不明显 ,IL 6、IL 8升高幅度低于对照组 (P <0 0 1、0 0 5 )。结论 抑肽酶可能降低体外循环术后IL 6、IL 8、TNF α等细胞因子水平 。

Objective: To evaluated the inhibitory effects of aprotinin on plasma TNF α, IL 6, IL 8 during and after cardiopulmonary bypass in children. Methods: 19 children with congenital heart disease were randomized to aprotinin group (n=10) or control group (n=9). Blood samples were collected during and after cardiopulmonary bypass in each group. Cytokines including tumor necrosis factor α(TNF α), IL 6 and IL 8 were measured respectively by ELISA (enzyme linked immunosorbent assay) technique with matched antibody pairs. Results: In control group, TNF α,IL 6 and IL 8 were significantly increased during and early after CPB. IL 8 and TNF α were returned to normal 24 hours after operation. No significant changes were noted in TNF α in aprotinin group. In comparison with control group, the increasing degree of IL 6 and IL 8 were significantly low. (P<0 05 or P<0 01). Conclusion: Aprotinin may inhibit cardiopulmonary bypass induced inflammation by the suppressing cytokine production such as TNF α, IL 6 and IL 8.