急性梗阻化脓性胆管炎患者PTCD治疗后血清、胆汁中细胞因子水平变化及意义

Cytokine changes in serum and bile in patients with acute obstructive suppurative cholangitis after PTCD treatment

目的探讨急性梗阻化脓性胆管炎患者经皮经肝穿刺胆管引流术(PTCD)治疗后血清、胆汁中细胞因子水平变化及临床意义。方法选择急性梗阻化脓性胆管炎患者80例,均行PTCD治疗,术后发生脓毒症32例(观察组),未发生脓毒症48例(对照组)。应用ELISA法检测两组手术前后血清及胆汁中细胞因子IL-1、IL-2、IL-4、IL-10、肿瘤坏死因子-α(TNF-α)水平。结果术前,两组血清、胆汁中IL-1、IL-2、IL-4、IL-10、TNF-α水平比较差异无统计学意义(P均>0.05);术后1、3 d,两组血清及胆汁中IL-1、IL-2、TNF-α均较术前下降(P均<0.05),但两组间比较差异无统计学意义(P均>0.05)。术后1、3 d,两组血清、胆汁IL-4水平均较术前升高(P均<0.05),但术后3 d,观察组血清IL-4水平与术后1 d差异无统计学意义(P>0.05)、胆汁中IL-4水平低于术后1 d(P<0.05),且均低于同期对照组(P均<0.05)。术后1、3 d,对照组血清、胆汁中IL-10水平均较术前升高(P均<0.05),但观察组较术前差异无统计学意义(P>0.05),且术后3 d,观察组血清、胆汁中IL-10水平均低于术后1 d(P均<0.05),并低于同期对照组(P均<0.05)。结论PTCD治疗后急性梗阻化脓性胆管炎患者血清、胆汁中细胞因子IL-4、IL-10水平降低;检测细胞因子水平有助于脓毒症发生的预测。

Objective To investigate the cytokine changes in serum and bile of acute obstructive suppurative cholangitis patients after percutaneous transhepatic cholangial drainage(PTCD)treatment.Methods Eighty patients with acute obstructive suppurative cholangitis were divided into the observation group(patients with sepsis after PTCD,n=32)and control group(patients without sepsis after PTCD,n=48).The levels of interleukin-1(IL-1),IL-2,IL-4,IL-10 and TNF-αin serum and bile before and after operation were measured by enzyme-linked immunosorbent assay(ELISA).Results There were no significant differences in the levels of IL-1,IL-2,IL-4,IL-10 or TNF-αin both serum and bile between the two groups before operation(all P>0.05),while the levels of IL-1,IL-2 and TNF-αin both serum and bile in the two groups were significantly lower as compared with those before(all P<0.05),with no statistical differences between the two groups(all P>0.05).At 1 and 3 days after operation,the levels of IL-4 in both serum and bile of the two groups were significantly higher than those before(P<0.05),however,the serum level of IL-4 had no statistical difference between 3 days and 1 day after operation(P>0.05),the level in bile was significantly lower than that at 1 day after operation(P<0.05),and both levels in the serum and bile of the observation group were lower than those of the control group in the same period(all P<0.05).At 1 and 3 days after operation,the levels of IL-10 in serum and bile of patients in the control group increased significantly than those before(P<0.05),but there were no statistical differences in the observation group between before and after operation(P>0.05),and the levels of IL-10 in both serum and bile of the observation group at 3 days after operation were significantly lower than those at 1 day after operation,and were lower than those of patients in the control group at the same period(all P<0.05).Conclusion After PTCD treatment,the decrease of IL-4 and IL-10 in bile and serum of patients with acute obstructive suppurative cholangitis may be a predictor of sepsis,and the detection of cytokines may have clinical significance in predicting the occurrence of sepsis.