腹部手术后细胞因子变化及其临床意义

CYTOKINE CHANGES IN PATIENTS OF POSTOPERATION OF ABDOMEN AND ITS CLINICAL SIGNIFICANCE

目的 :探讨腹部手术后细胞因子TNF ,IL - 6和IL - 8的变化及其临床意义。方法 :观察 5 6例腹部手术患者 ,腹腔感染组 2 8例 ,对照组 2 8例。采用ELISA法检测患者静脉血术前、术后TNF ,IL - 6和IL - 8的水平变化。结果 :感染组与对照组术前静脉血TNF ,IL - 6和IL - 8水平有显著差异 (P <0 .0 1) ,感染组患者静脉血TNF ,IL - 6和IL - 8水平显著高于对照组 ,其中IL - 6升高最为明显 ,较对照组高 2 0倍。对照组患者术后第 1天静脉血TNF ,IL - 6和IL - 8水平较术前有升高 ,术后第 5 ,7天与术前相比无显著性差异 (P >0 .0 5 )。感染组患者手术后TNF ,IL - 6和IL - 8水平仍高于对照组。与术前相比 ,感染组TNF ,IL - 6和IL- 8水平第 1天均有升高 (P <0 .0 1) ,术后 3d与术前水平无显著差异 (P >0 .0 5 )。术后 7d感染组血TNF ,IL- 6和IL - 8水平较术前显著下降 (P <0 .0 1)。感染组血TNF ,IL - 6和IL - 8水平患者病情好转而逐渐降低。经相关分析证明两组中TNF与IL - 6 ,TNF与IL - 8及IL - 6与IL - 8之间均呈正相关。结论 :腹腔感染患者静脉血TNF ,IL - 6和IL - 8的水平明显增高 ,检测腹部术后患者TNF ,IL - 6和IL - 8的水平变化 ,可作为观察和预测术后恢复及感染患者病情转归的指标。

Objective:To determine cytokine changes of TNF, IL-6,IL-8 and their clinical significance. Methods:Fifty-six cases of abdomen operations including 28 abdominal cavity infection patients and 28 patients of no-abdominal infection operations as control were involved in our study. ELISA method was used to detect level changes of TNF, IL-6 and IL-8 in venous blood before and after operation. Results:TNF, IL-6 and IL-8 level in infection group were higher than that in control group. The differences between groups were significant ( P <0.01 ). IL-6 level of infection group was twentyfold over that of no-infection group. In control group, TNF, IL-6 and IL-8 increased at the first day after operation,but recovered to normal at the fifth day. In comparison with before operation, the levels of TNF, IL-6 and IL-8 of infection group increased at the first day after operation, then dropped to the level before operation at the the third day, and reduced significantly at the seventh day. The cytokin levels dicreased as infection alleviated. Positive correlations were proved between TNF and IL-6, TNF and IL-8, IL-6 and IL-8 by correlation analysis. Conclusion:Cytokin levels of TNF, IL-6 and IL-8 increased markedly in patients with abdominal infection. The cytokin level changes can serve as an indication of infection prognosis.