婴儿体外循环期间可溶性细胞粘附因子-1、IL-8、TNF-α变化及其与中性粒细胞肺内扣押程度的相关性分析

Variation of sICAM-1,IL-8 and TNF-α and their correlations with the degree of potassium in the lung during cardiopulmonary bypass

目的观察婴儿体外循环(CPB)期间炎性反应过程中可溶性细胞粘附因子-1(s ICAM-1)、IL-8、肿瘤坏死因子α(TNF-α)变化规律及其与中性粒细胞肺内扣押程度、体外循环时间、主动脉阻断时间的相关性。方法选取2011年1月—2015年9月在河北工程大学附属医院行CPB下先天性心脏病(CHD)手术的30例患儿,患儿分别于CPB前(T_1)、CPB 40min(T_2)、CPB停机(T_3)及停机后2h(T_4)、6h(T_5)和24h(T_6)共6个不同时间点采用酶联免疫法(ELISA)测定血清TNF-α、IL-8、s ICAM-1水平,体外循环开始前及结束时取左右心房血测定中性粒细胞数值,计算中性粒细胞跨肺差值。将中性粒细胞跨肺差值与体外循环时间、主动脉阻断时间、s ICAM-1、TNF-α、IL-8的高峰浓度做相关性分析。结果 TNF-α、IL-8、中性粒细胞计数在T_2、T_3、T_4、T_5、T_6时间点高于T_1,差异有统计学意义(P<0.05)。CPB前后左右心房中性粒细胞跨肺差值比较,差异有统计学意义(P<0.05)。中性粒细胞跨肺差值与CPB时间、主动脉阻断时间、s ICAM-1、IL-8呈正相关(r=0.732、0.830、0.855、0.784,P<0.01)。围CPB期TNF-α与中性粒细胞呈正相关(r=0.209,P<0.05)。结论 CPB可引起炎性递质释放,导致中性粒细胞黏附滞留于未成熟肺内,产生肺炎性反应,细胞因子的变化与肺功能损伤存在相关性。

Objective To observe the variation of soluble cell adhesion molecules- 1（ s ICAM- 1）,interleukin- 8（ IL- 8） and tumor necrosis factor- α（ TNF- α） in infants with cardiopulmonary bypass（ CPB）,to analyze the correlation swith,the degree of potassium in the lungs,the CPB time and aortic cross- clamp time. Methods A total of 30 infants with congenital heart disease under extra- corporeal circulation were selected in Hebei Engineering University Affiliated Hospital from January 2011 to September 2015. The concentrations of serum TNF- α,IL- 8 and s ICAM- 1 were detected by enzyme- linked immunosorbent assay（ ELISA） at six different time points: after CPB（ T1）,after 40 minutes of CPB（ T2）,CPB shut down（ T3）,2 hours after downtime（ T4）,6 hours after downtime（ T5） and 24 hours after downtime（ T6）,respectively. The left and right heart atrial blood were drawed respectively before and after the cardiopulmonary bypass,and the value of neutrophils of the blood was detected and the neutrophils across the lungs was calculated. Finally,the correlations between neutrophils across the lungs,the CPB time,aortic cross- clamp time,and the peak concentration of s ICAM- 1,TNF- α and IL- 8 were analyzed. Results At the T2,T3,T4,T5,T6 point the TNF- α,IL- 8 neutrophil count were higher than T1 point（ P <0. 05）. Left atrial neutrophils across lungs before and after CPB were compared,the differences were statistically significant（ P< 0. 05）. Neutrophils across the lungs were positively correlated with CPB time,aortic cross- clamp time,s ICAM- 1,IL- 8（ r = 0. 732,0. 830,0. 855,0. 784,P < 0. 01）. TNF- α was pesitively correlate with neutrophils（ r = 0. 209,P < 0. 05）.Conclusion Cardiopulmonary bypass can cause the release of inflammatory media,which leads to the adhesion and retention of neutrophils in immature lung. There is clear correlation among the degree of pulmonary retention,aortic cross- clamp time,and the concentration of s ICAM- 1 and IL- 8 in blood.