Wen Xiao-Hong, Kong Hai-Ying, Zhu Sheng-Mei, Xu Jian-Hong, Huang Su-Qin, Chen Qing-Lian
Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2004 Feb;3(1):38-41.
Pulmonary complications after orthotopic liver transplantation (OLT) include high morbidity and mortality. Experimental data have suggested hepatic ischemia and reperfusion are induced by pro-inflammatory cytokines. The high level of inflammatory cytokines might additionally influence pulmonary capillary fluid filtration. The objectives of this study were to measure the concentrations of tumor necrotic factor-alpha (TNF-alpha), interleukin-6 (IL-6) and interleukin-8 (IL-8) during OLT and to investigate the relationship between these cytokines and postoperative pulmonary complications.
Twenty-two patients undergoing OLT were divided into two groups according to whether they had postoperative pulmonary complications: group A consisting of 8 patients with postoperative pulmonary complications, and group B consisting of 14 patients without postoperative pulmonary complications. Enzyme-linked immunoassay (ELISA) was used to determine serum TNF-alpha, IL-6 and IL-8. Blood samples were taken at the beginning of operation (T0), clamping and cross-clamping of the inferior cava and portal vein (T1, T2), 90 minutes and 3 hours after reperfusion (T3, T4) and 24 hours after operation (T5).
The level of PaO2/FiO2 in group A was lower than that in group B (P<0.05). The concentrations of TNF-alpha, IL-6 and IL-8 in the two groups increased rapidly at T2, peaked at T3, decreased rapidly after T3 until 24 hours after operation. The concentrations of TNF-alpha, IL-6 and IL-8 in group A were higher than those in group B at T2, T3, and T4 (P<0.05).
After un-clamping of the inferior cava and portal vein, the serum concentrations of TNF-alpha, IL-6 and IL-8 increased may be related to pulmonary injury after hepatic ischemic reperfusion.
原位肝移植（OLT）后的肺部并发症包括高发病率和死亡率。实验数据表明，促炎细胞因子可诱导肝脏缺血和再灌注。高水平的炎性细胞因子可能还会影响肺毛细血管液体滤过。本研究的目的是测量OLT期间肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-8（IL-8）的浓度，并研究这些细胞因子与术后肺部并发症之间的关系。
22例行OLT的患者根据是否发生术后肺部并发症分为两组：A组8例发生术后肺部并发症，B组14例未发生术后肺部并发症。采用酶联免疫吸附测定（ELISA）法测定血清TNF-α、IL-6和IL-8。在手术开始时（T0）、下腔静脉和门静脉夹闭及松开时（T1、T2）、再灌注后90分钟和3小时（T3、T4）以及术后24小时（T5）采集血样。
A组的PaO2/FiO2水平低于B组（P<0.05）。两组中TNF-α、IL-6和IL-8的浓度在T2时迅速升高，在T3时达到峰值，T3后迅速下降直至术后24小时。在T2、T3和T4时，A组中TNF-α、IL-6和IL-8的浓度高于B组（P<0.05）。
下腔静脉和门静脉松开后，血清TNF-α、IL-6和IL-8浓度升高可能与肝脏缺血再灌注后的肺损伤有关。
