心肺转流术后血细胞因子、T淋巴细胞亚群变化与肝损伤的关系

Relationship between the changes of cell factors and T-cell subtypes and hepatic injury after cardiopulmonary bypass

目的 探讨心肺转流 (CPB)术前后患者血细胞因子、T淋巴细胞亚群变化与肝损伤的关系。方法 对 30例风湿性心脏病心脏瓣膜置换病人在其CPB手术前、术后第 1、3、7、14天 ,应用小鼠胸腺增殖法检测IL 1活性 ,用CDLI2 依赖细胞增殖法检测IL 2活性 ,用ELISA法检测TNF α水平 ,用APAAP法检测CD4、CD8,用赖氏法检测ALT。结果 IL 1于术后第 1天显著高于术前 (P <0 0 1) ,术后第 3、7天则明显低于术前 (P <0 0 5 )。IL 2于术后第 1、3、7天明显低于术前 (P <0 0 1或 0 0 5 )。TNF α于术后第 1、3天明显高于术前 (P <0 0 5 )。CD4、CD4/CD8于术后第 1、3、7天明显低于术前 (P <0 0 1或 0 0 5 )。ALT于术后第 1、3、7天明显高于术前 (P <0 0 1或 0 0 5 )。ALT与CD4、IL 2呈负相关(r1=0 4 3,P <0 0 5 ;r1=0 4 1,P <0 0 5 )。结论 CPB手术应激、各种药物作用等可引起病人多种细胞因子、T淋巴细胞亚群的变化 。

Objective To investigate the relationship between the changes of cell factors and T cell subtypes and hepatic injury after cardiopulmonary bypass (CPB).Method Thirty patients with rheumatic heart disease undergoing valvular replacement were selected in this study.Interlukin 1(IL 1),interlukin 2(IL 2),tumor necrosis factor α (TNF α),CD 4,CD 8 and ALT were measured before CPB,on the 1st,3rd,7th and 14th postoperative day.Results The activity of IL 1 was significantly higher on the 1st postoperative day than that before CPB,but lower on the 3rd and 7th postoperative day than that before CPB.The activity of IL 2 was significantly lower on the 1st,3rd and 7th postoperative day than that before CPB.CD 4 and CD 4/CD 8 were significantly lower on the 1st,3rd and 7th postoperative day than those before CPB.ALT level was significantly increased on the 1st,3rd and 7th postoperative day compared with that before CPB,and negatively corelated with CD 4 and IL 2 ( r 1= 0 43, P< 0 05; r 2= 0 41, P< 0 05).Conclusion Surgical stress and drug administration can result in the changes of cell factors and T cell subtypes,which may be one of the factors leading to hepatic injury after CPB. [