Mal H, Dehoux M, Sleiman C, Boczkowski J, Lesèche G, Pariente R, Fournier M
Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Clichy, France.
Chest. 1998 Mar;113(3):645-51. doi: 10.1378/chest.113.3.645.
Systemic hypotension may complicate the early postoperative period after lung transplantation. A release of proinflammatory cytokines secondary to lung ischemia/reperfusion injury could be involved in the pathogenesis of this early hemodynamic failure (EHF).
To assess prospectively whether the occurrence of EHF is associated with a release of cytokines in the systemic circulation.
Blood samples were taken daily during the first postoperative week in 26 patients who underwent a double or a single-lung transplantation. These patients were divided into three groups: 7 patients who experienced EHF and subsequently died (EHF group); 15 patients without EHF (control group); and 4 patients without EHF but with an identified sepsis (sepsis group). The serum levels of interleukin (IL)-1beta, tumor necrosis factor-alpha (TNF-alpha), IL-6, and IL-8 were compared among the three groups.
In the EHF group, the levels of each cytokine peaked at day 1 postoperatively. Cytokine levels at day 1 were significantly higher in the EHF group than in the control group (p<0.0006) or in the sepsis group (p<0.003 except for TNF-alpha).
We conclude that EHF is associated with a massive release of proinflammatory cytokines that could play a determinant role in the pathogenesis of this complication.
系统性低血压可能使肺移植术后早期情况复杂化。继发于肺缺血/再灌注损伤的促炎细胞因子释放可能参与了这种早期血流动力学衰竭（EHF）的发病机制。
前瞻性评估EHF的发生是否与全身循环中细胞因子的释放有关。
对26例行双肺或单肺移植的患者在术后第一周每天采集血样。这些患者被分为三组：7例发生EHF并随后死亡的患者（EHF组）；15例未发生EHF的患者（对照组）；4例未发生EHF但确诊为脓毒症的患者（脓毒症组）。比较三组患者血清白细胞介素（IL）-1β、肿瘤坏死因子-α（TNF-α）、IL-6和IL-8水平。
在EHF组，每种细胞因子水平在术后第1天达到峰值。EHF组术后第1天的细胞因子水平显著高于对照组（p<0.0006）或脓毒症组（除TNF-α外，p<0.003）。
我们得出结论，EHF与促炎细胞因子的大量释放有关，这些细胞因子可能在这种并发症的发病机制中起决定性作用。
