脂氧素A4在体外循环期间的变化和相关性分析

Dynamic Changes and Correlation of LXA 4 in Patients Undergoing Cardiac Valve Replacement During Cardiopulmonary Bypass

目的探讨心脏瓣膜置换术体外循环期间脂氧素A4(LXA4)的变化及其与肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-10和中性粒细胞(PMN)的相关性。方法选择拟行心脏瓣膜置换术的患者30例,其中,男性13例,女性17例,年龄38-72岁,ASA Ⅱ~Ⅲ级,分别于麻醉诱导前(T1)、体外循环(CPB)30min(T2)、CPB停机时(T1)、停机后3h(T4)、6h(T5)、24h(T6)时测定全血中性粒细胞计数以及血清中TNF-α、IL-6、IL-10和LXA4的浓度。结果与片时比较,LXA4、IL-10、TNF-α、IL-6、PMN水平在各时间点均明显升高(P<0.05);LXA4于T,时达到高峰后逐渐下降,于T6时再次升高(P<0.05);IL-10在T,时达到高峰,之后逐渐下降(P<0.05);TNF-α浓度和PMN计数于T<时达到高峰后逐渐下降,于T4时再次升高(P<0.05);IL-6于T5时达到高峰后逐渐下降(P<0.05);Spearman相关分析血清LXA4水平与IL-10、TNF-α和PMN计数之间呈相关性(P<0.05)t结论CPB可触发心脏瓣膜置换患者全身炎性反应,表现为中性粒细胞和促炎细胞因子(TNF-α、L-6)水平升高,同时抗炎细胞因子IL-10和促炎症消退介质LXA4更早被激活,以促进全身炎性反应的消退。

Objective To investigate the dynamic changes of lipoxin A 4(LXA 4)and its correlation with tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-10 and polymorph nuclear cell(PMN)during cardiopulmonary bypass(CPB)in patients undergoing cardiac valve replacement.Methods Thirty patients with heart valve disease who underwent cardiac valve replacement,13 males and 17 females,aged 38 to 72 years,ASA II-ID.were selected.The serum levels of TNF-α,IL-6,IL-10 and LXA4 were measured by enzyme-linked immunosorbent assay(ELISA)method,and the amount of neutrophils was also measured.Serial blood samples were collected at the following intervals respectively:before anesthesia induction(T1),30min after CPB(T2)and 0h(T3),2h(T4),6h(T5),24h(T6)after the end of CPB.Results Compared with these at T,,the levels of LXA4,IL-10,TNF-α,IL-6 and and the amount of neutrophils increased significantly at each time point(P<0.()5).LXA4 decreased gradually after reaching the peak at T3,and increased again at T6(P<0.05).IL-10 reached the peak at T3,and then decreased gradually(P<0.05).TNF-α concentration and PMN number decreased gradually after reaching the peak at T4 and increased again al T6(P<0.05).IL-6 decreased gradually after reaching the peak at T5(P<0.05).Serum LXA4 level was correlated with IL-10,TNF-αand PMN number by Spearman correlation analysis(P<0.05).Conclusion Cardiopulmonary bypass can lead to systemic inflammatory response in patients with heart valve replacement,which is characterized by an increase in the level of polymorph nuclear cells and proinflammatory cytokines(TNF-a,L-6),and the activation of anti-inflammatory cytokines IL-10 and proinflammatory mediators LXA4 earlier to promote the regression of systemic inflammatory response.