Pärsson H N, Nässberger L, Norgren L
Department of Surgery, Lund University, Sweden.
Int Angiol. 1997 Mar;16(1):55-64.
To evaluate the systemic release of major cytokines and complemental activation during elective aorto-bifemoral bypass surgery and the influence on the postoperative course.
Prospective randomised study.
University hospital, Sweden.
Fourteen consecutive patients with aorto-iliac occlusive disease were randomised to receive either a bifurcated e PTFE graft with stretch properties or a collagen coated Dacron graft.
Immunologic parameters were assessed and included the cytokines TNF alpha (tumor necrosis factor), IL-6, IL-8, S-IL-2R and complemental factor C5a. Furthermore, acute plasma proteins, including C-reactive protein, and the different white blood cell fractions were determined. Sampling was performed frequently during surgery and postoperatively up to one month.
An increase of serum-TNF alpha levels was observed early after declamping. This response preceded an increase of IL-6 levels and of C-reactive protein. No release of IL-8 was identified. A significant correlation between TNF alpha, IL-6 and C-reactive protein was observed (p < 0.001). A positive correlation was also observed for the degree of surgical trauma (blood loss). No significant differences between the two graft materials were encountered. The complemental system was also involved in the acute reactions and a marked increase of C5a levels was noted. A decrease of S-IL-2R levels as well as lymphocyte concentrations was also observed postoperatively and was interpreted as a downregulation of the immune-system in the immediate postoperative course.
The results demonstrate an early and generalized inflammatory response during and after aortic surgery with involvement of different cytokines as well as the complemental system. TNF alpha appears to play a central role in the release of other cytokines, but IL-6 seemed to correlate best with later development of nonvascular complications. Few differences were found between the different grafts and the response seems to be influenced by other factors such as the surgical procedure and ischaemia/reperfusion injury.
评估择期主-双股动脉搭桥手术期间主要细胞因子的全身释放及补体激活情况，以及对术后病程的影响。
前瞻性随机研究。
瑞典的大学医院。
14例连续性主-髂动脉闭塞性疾病患者被随机分为两组，分别接受具有拉伸特性的分叉型膨体聚四氟乙烯（ePTFE）人工血管或胶原涂层涤纶人工血管。
评估免疫参数，包括细胞因子肿瘤坏死因子α（TNFα）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、可溶性白细胞介素-2受体（S-IL-2R）和补体因子C5a。此外，还测定了急性血浆蛋白，包括C反应蛋白，以及不同的白细胞分类。在手术期间及术后长达1个月内频繁进行采样。
松开血管夹后早期观察到血清TNFα水平升高。这种反应先于IL-6水平和C反应蛋白升高。未发现IL-8释放。观察到TNFα、IL-6和C反应蛋白之间存在显著相关性（p < 0.001）。手术创伤程度（失血量）也呈正相关。两种人工血管材料之间未发现显著差异。补体系统也参与了急性反应，且C5a水平显著升高。术后还观察到S-IL-2R水平以及淋巴细胞浓度降低，这被解释为术后即刻免疫系统的下调。
结果表明主动脉手术期间及术后存在早期全身性炎症反应，不同细胞因子以及补体系统均参与其中。TNFα似乎在其他细胞因子的释放中起核心作用，但IL-6似乎与后期非血管并发症的发生最为相关。不同人工血管之间差异不大，且该反应似乎受手术操作和缺血/再灌注损伤等其他因素影响。
