Frering B, Philip I, Dehoux M, Rolland C, Langlois J M, Desmonts J M
Département d'Anesthésie et de Réamination Chirurgicale, Unité INSERM U408, Paris, France.
J Thorac Cardiovasc Surg. 1994 Oct;108(4):636-41.
To determine the cytokine release during normothermic cardiopulmonary bypass, we have measured plasmatic levels of tumor necrosis factor-alpha and interleukins-1 beta, 6, and 8 in 10 patients during the first 24 hours after the start of bypass. Arterial blood samples were collected at intervals before, during, and after bypass. Interleukin-1 beta was not detectable in the plasma, and traces of tumor necrosis factor-alpha were detected in only three patients at times independent of the cardiopulmonary bypass procedure. Circulating endotoxin remained undetectable. Plasma interleukin-6 and interleukin-8 rose significantly from 2 until 24 hours after the start of bypass (p < 0.05) and peaked respectively at 4 and 2 hours after the beginning of bypass (interleukin-6, 268.1 +/- 131.43 pg/ml; interleukin-8, 370 +/- 420 pg/ml; mean peak +/- standard deviation). Peak values of interleukin-6 and interleukin-8 were correlated neither with the duration of aortic crossclamping or the bypass procedure nor with the hemodynamic parameters recorded at the same times. This study shows that normothermic cardiopulmonary bypass does not induce systemic release of tumor necrosis factor-alpha and interleukin-1 beta. A local production of these cytokines cannot be excluded, because interleukin-6 and interleukin-8 are produced by stimulated macrophages and monocytes in response to tumor necrosis factor-alpha and interleukin-1 beta. Our results, at normothermia, show a similar pattern of interleukin-6 and interleukin-8 release when compared with release during hypothermic cardiopulmonary bypass. Interleukin-8, an important chemotactic neutrophil factor, might play a role in reperfusion injuries observed in lungs and heart after cardiopulmonary bypass.
为了确定常温体外循环期间细胞因子的释放情况，我们在10例患者体外循环开始后的最初24小时内，测定了血浆中肿瘤坏死因子-α以及白细胞介素-1β、6和8的水平。在体外循环前、期间和之后，定期采集动脉血样本。血浆中未检测到白细胞介素-1β，仅在3例患者中检测到微量肿瘤坏死因子-α，且时间与体外循环过程无关。循环内毒素仍未检测到。血浆白细胞介素-6和白细胞介素-8在体外循环开始后2小时至24小时显著升高（p<0.05），分别在体外循环开始后4小时和2小时达到峰值（白细胞介素-6，268.1±131.43 pg/ml；白细胞介素-8，370±420 pg/ml；平均峰值±标准差）。白细胞介素-6和白细胞介素-8的峰值与主动脉阻断时间或体外循环时间均无关，也与同一时间记录的血流动力学参数无关。本研究表明，常温体外循环不会诱导肿瘤坏死因子-α和白细胞介素-1β的全身释放。不能排除这些细胞因子的局部产生，因为白细胞介素-6和白细胞介素-8是由受刺激的巨噬细胞和单核细胞响应肿瘤坏死因子-α和白细胞介素-1β而产生的。我们在常温下的研究结果表明，与低温体外循环期间的释放情况相比，白细胞介素-6和白细胞介素-8的释放模式相似。白细胞介素-8是一种重要的趋化中性粒细胞因子，可能在体外循环后肺和心脏观察到的再灌注损伤中起作用。
