腹部手术后细胞因子及其它介质的变化

Alteration of Cytokine and Other Media Following Abdominal Operation

目的 :探讨腹部手术后细胞因子及其它介质的变化与意义。 方法 :动态观察 2 1例腹部外科患者术后外周血白细胞介素 - 6 (IL - 6 )、新喋呤、降钙素基因相关肽 (CGRP)、P物质 (SP)、内毒素、一氧化氮 (NO)、一氧化氮合酶 (NOS)、脂质过氧化物 (LPO)、总抗氧化能力 (TAO)等变化。 结果 :术后当日、第 3dIL - 6 ,术后当日内毒素和第 3、7d新喋呤均高于正常人。IL- 6、内毒素术后当日明显高于其它时间点 ;新喋呤在术后较术前有所增高 ,癌症较之非癌症患者术后第 3d新喋呤增高 (P =0 0 5 7) ,第 7d显著增高。术后第 7dSP明显低于正常组 ,且术后低于术前 ,第 7d尤低 ;术后第 3、7dCGRP明显高于正常组 ,且术后高于术前 ,第 7d尤高 ,第 14d高于其它时间点。NO于术后 1周内明显降低 ,术后当日尤低 ,2周时接近正常组 ;NOS的变化趋势同NO ;术后LPO及TAO进行性降低并低于术前 ,但LPO仍高于正常组。 结论 :中等以上腹部手术引起外周血IL -6、新喋呤和内毒素水平升高 ;其中恶性肿瘤患者术后新喋呤升高更明显。术后SP降低可能影响肠功能 ;CGRP升高便于组织存活。NO降低可能与组织低灌注有关。术后脂质过氧化作用减弱 ,总抗氧化能力亦降低。

Objective To evaluate the changes of cytokines and other media following abdominal operation Methods Dynamic determination of interleukin-6(IL-6),neopterin,calcitonin gene-related peptide(CGRP),substance P(SP),endotoxin,nitric oxide(NO),nitric oxide synthase(NOS),lipid peroxide(LPO),total anti-peroxidation capacity(TAO)were done in peripheral blood of 21 patients before and after operation(group A);17 healthy persons served as normal control(group B).Results Plasma IL-6 and endotoxin levels in group A at the end of the operation (namely POD 0) were higher than those in group B respectively( P <0.01).IL-6 taken on the third postoperative day (POD 3) and serum neopterin on POD 3 and POD 7 in group A were higher than those in group B ( P <0.05, P <0.01) respectively;IL-6 and endotoxin levels on POD 0 were higher than those at other time points ( P <0.05).Neopterin levels showed some elevation at any time points in the postoperative period than those before operation;neopterin levels in patients with cancer showed slight elevation than those in noncancerous patient ( P =0.0057) on POD 3,and rose significantly on POD 7.SP levels in group A on POD 7 were lower than those in group B( P <0.05).CGRP levels in group A on POD 3 and POD 7 were higher than those in group B( P <0.05),SP levels showed some decrease at each time point after operation than those before operation ,especially on POD 7;CGRP levels showed some elevation after operation,on POD 7 they were higher than those before operation( P <0.05),peaked on POD 14,being higher than those at other time points.NO levels in group A on POD 0,3,7 were lower than those in group B( P <0.01),especially on POD 0 approaching those in group B on POD 14;NOS levels before operation and on POD 0,3,7 in group A were lower than those in group B,and on POD 0 lower than those before operation( P <0.05);LPO and TAO level were decreasing postoperatively,and on POD 7,14 or on POD 3,7 lower than those before operation,but LPO levels were still higher than those in group B( P <0.05). Conclusion Major and submajor abdominal operations lead to elevation of IL 6,neopterin and endotoxin level in the peripheral blood;neopterin levels in patients with cancer obviously rise postoperatively higher than in those without cancer.The postoperative decrease of SP may be disadvantageous to bowel function,while elevation of CGRP may be beneficial to tissue survival.The decrease of NO may be related to tissue hypo- perfusion .After operation lipid peroxidation and total antiperoxidation capacity may also be affected.