先天性心脏病合并肺动脉高压患者围术期IL-17水平的变化

Observation of IL-17 levels of perioperative period in congenital heart disease patients with pulmonary hypertension

目的探讨成人先天性心脏病合并肺动脉高压患者围手术期血浆白细胞介素-17(IL-17)水平变化的规律及意义。方法择期体外循环(CPB)下行先天性心脏病修补术患者40例,根据肺动脉收缩压(PASP)分为非肺动脉高压组(Ⅰ组,PASP<30 mm Hg)以及肺动脉高压组(Ⅱ组,PASP≥30 mm Hg)。于麻醉诱导前(T_1)、CPB即刻(T_2)、停CPB后30 min(T_3)、术后6 h(T_4)、术后24 h(T_5)以及术后7 d(T_6)采集动脉血标本,检测血浆IL-17的水平,同时测定前5个时点患者的动脉氧分压[p(O_2)]及二氧化碳分压[p(CO_2)],计算氧合指数(OI)及肺泡-动脉氧分压差(AaDO_2)。结果整个围手术期Ⅱ组血浆IL-17水平高于Ⅰ组(P<0.05),且2组IL-17水平均于T3期达到峰值,之后降低;此时2组OI降低,而AaDO_2却明显升高。术后24 h(T_5),与Ⅰ组相比,Ⅱ组OI下降,AaDO_2出现升高(P<0.05)。结论高水平的IL-17在先天性心脏病肺动脉高压的形成中起一定促进作用,可能参与了CPB后的肺损伤,可作为评估病情的指标。

Objective To discuss the changes and significance of interleukin-17(IL-17) in perioperative period ofcongenital heart disease patients with pulmonary hypertension. Methods A total of forty patients with congenital heartdisease underwent cardiopulmonary bypass(CPB) were included in this study. According to the pulmonary artery systolicpressure(PASP), patients were divided into non-pulmonary hypertension group(group Ⅰ, PASP < 30 mm Hg) andpulmonary hypertension group(group Ⅱ, PASP≥30 mm Hg). Blood samples were taken before anesthesia(T_1), start CPB(T_2),30 min after CPB(T_3), 6 h(T_4), 24 h(T_5) and 7 d(T_6) after operation. The concentration of IL-17 was detected by ELISA.Arterial oxygen partial pressure [p(O_2)] and arterial carbon dioxide partial pressure [p(CO_2)] during the first five time pointswere recorded. Oxygen index(OI) and alveolar arterial oxygen tension difference(AaDO_2) were calculated. Results Theplasma IL-17 levels in perioperative period were significantly higher in group Ⅱ than those of group Ⅰ(P < 0.05). Thehighest concentration of IL-17 emerged at T_3, then decreased gradually in both groups. At this time point, the OI decreased,and AaDO_2 increased significantly in both groups. Compared with groupⅠ, the OI decreased, while AaDO_2 increased at T_5 ingroupⅡ(P <0.05). Conclusion The high level of IL-17 promotes the formation of pulmonary hypertension in congenitalheart disease and leads to the lung injury during CPB, which can be used as a clinical monitoring indicator of evaluatingseverity.