[通过清除心脏直视手术患者细胞因子对肾脏和肺部功能的保护作用]

[The protective effects to the function of kidney and long by clearing of cytokines in patients with open-heart surgery].

作者信息

Zhang Guo-hua, Hou Fan-fan, Wang Wu-jun, Zhang Xun, Wu Hua, Liu Zhi-qiang, Tao Hui-qin

机构信息

Division of Nephrology, Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2005 Nov 30;85(45):3194-8.

DOI:

PMID:16405839

Abstract

OBJECTIVE

To observe the effect of cytokines absorption on renal and respiratory function in patients with open-heart surgery.

METHODS

30 patients undergoing valve replacement with cardiopulmonary bypass (CPB) were randomly divided into two groups. A sulfonated polyacrylonitrile hemofilter (AN69) that has been used to absorb cytokines was connected into the efferent limb of CPB in Group A (n = 15), and a cellulose triacetate hemofilter (CT 190G) instead of AN69 was used as controls (Group B, n = 15). The levels of plasma pro-inflammatory (TNF-alpha, IL-6, IL-8) anti-inflammatory cytokines (IL-10, IL-1ra), C-reactive protein (CRP) levels, and post-operation renal and respiratory function were compared between the two groups. Blood samples were analysed for TNF-alpha and IL-6 and IL-8 and C-reactive protein (CRP). The changes in renal, respiratory function were also observed.

RESULTS

(1) At the end of CPB, TNF-alpha 10 ng/L +/- 3 ng/L and IL-6 115 ng/L +/- 22 ng/L levels in Group A were significantly lower than that in Group B 13 ng/L +/- 3 ng/L, 134 ng/L +/- 29 ng/L) respectively (P < 0.05 in all). There is no statistical differences in plasma IL-10 and IL-1ra levels between the two groups. (2) After 24 hours of CPB, the magnitude of increased body temperature, heart rate, white blood cell and plasma CRP in Group A [1.6 degrees C +/- 0.2 degrees C, 15/min +/- 4/min, (17 +/- 3) x 10(9)/L, 56 mg/L +/- 13 mg/L], were significantly lower than that in Group B [2.1 degrees C +/- 0.2 degrees C, 23/min +/- 6/min, (22 +/- 3) x 10(9)/L, 69 mg/L +/- 15 mg/L] respectively (P < 0.05 in all). (3) After 24 hours of CPB, the levels of 24h urinary protein excretion and urinary N-acetyl-beta-D-glucosaminidase (NAG) were significantly lower in Group A when compared to that in Controls (0.20 g/d +/- 0.08 g/d vs 0.30 g/d +/- 0.14 g/d, 28 U/L +/- 11 U/L vs 38 U/L +/- 13 U/L respectively), P < 0.05 in all. The level of creatinine clearance (Ccr) in Group A (68 +/- 7) ml.min(-1).1.73 m(-2) was significantly elevated than that in Group B (57 +/- 11) ml.min(-1).1.73 m(-2) (P < 0.05). (4) One hour after the end of CPB, the magnitude of increased plateau airway pressure (P(Plateau)) and peak airway pressure (P(Peak)) in Group A were significantly lower than that in Controls (P < 0.01 in all). The duration that need mechanical ventilation after operation in Group A (4.9 h +/- 0.6 h) was much shorter than that in Group B (5.8 h +/- 0.8 h, P < 0.05).

CONCLUSIONS

Lowering the plasma levels of cytokines by extracorporeal absorption may attenuate systemic inflammatory response and protect lung and kidney function in patients with open-heart surgery.

摘要

目的

观察细胞因子吸附对心脏直视手术患者肾脏及呼吸功能的影响。

方法

30例行体外循环（CPB）瓣膜置换术的患者随机分为两组。A组（n = 15）将已用于吸附细胞因子的磺化聚丙烯腈血液滤过器（AN69）连接至CPB的流出道，B组（n = 15）使用三醋酸纤维素血液滤过器（CT 190G）代替AN69作为对照。比较两组患者血浆促炎细胞因子（TNF-α、IL-6、IL-8）、抗炎细胞因子（IL-10、IL-1ra）水平、C反应蛋白（CRP）水平及术后肾脏和呼吸功能。检测血样中的TNF-α、IL-6、IL-8及C反应蛋白（CRP）。同时观察肾脏、呼吸功能的变化。

结果

（1）CPB结束时，A组TNF-α水平为10 ng/L±3 ng/L，IL-6水平为115 ng/L±22 ng/L，显著低于B组的13 ng/L±3 ng/L、134 ng/L±29 ng/L（均P < 0.05）。两组血浆IL-10和IL-1ra水平无统计学差异。（2）CPB 24小时后，A组体温、心率、白细胞及血浆CRP升高幅度[1.6℃±0.2℃、15次/分钟±4次/分钟、（17±3）×10⁹/L、56 mg/L±13 mg/L]显著低于B组[2.1℃±0.2℃、23次/分钟±6次/分钟、（22±3）×10⁹/L、69 mg/L±15 mg/L]（均P < 0.05）。（3）CPB 24小时后，A组24小时尿蛋白排泄量及尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）水平显著低于对照组（分别为0.20 g/d±0.08 g/d 对0.30 g/d±0.14 g/d，28 U/L±11 U/L对38 U/L±13 U/L），均P < 0.05。A组肌酐清除率（Ccr）为（68±7）ml·min⁻¹·1.73 m⁻²，显著高于B组的（57±11）ml·min⁻¹·1.73 m⁻²（P < 0.05）。（4）CPB结束后一小时，A组平台气道压（P(Plateau)）及峰值气道压（P(Peak)）升高幅度显著低于对照组（均P < 0.01）。A组术后机械通气时间（4.9 h±0.6 h）明显短于B组（5.8 h±0.8 h，P < 0.05）。