Matsutani T, Onda M, Sasajima K, Miyashita M
First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Tokyo, Bunkyo-ku, 113, Japan.
J Surg Res. 1998 Oct;79(2):158-63. doi: 10.1006/jsre.1998.5404.
Major surgery, such as esophagectomy, activates inflammatory responses and the coagulation system, and this activation is characterized by release of inflammatory cytokines and a decrease in antithrombin-III (AT-III), respectively. Preoperative glucocorticoid administration has been reported to suppress circulatory cytokine levels after major surgery.
A total of 28 patients underwent esophagectomy for esophageal carcinoma; 14 of them were given 10 mg/kg of methylprednisolone intravenously upon induction of anesthesia and 14 served as controls. Circulating levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), polymorphonuclear (PMN) elastase, thrombin-antithrombin III complex (TAT), AT-III, and albumin were measured before and immediately after the operation and on postoperative days (PODs) 1, 3, 5, and 7.
TNF-alpha, IL-6, and TAT levels significantly increased after esophagectomy in both groups. AT-III and albumin decreased to their minimum levels on POD 1 and POD 3, respectively. Methylprednisolone treatment effectively inhibited the increases in TNF-alpha and IL-6 and the decreases in AT-III and albumin, but did not inhibit the increases in PMN-elastase and TAT levels. There were significant correlations between AT-III, IL-6, and albumin levels.
These results suggest that methylprednisolone pretreatment attenuates the decrease in AT-III by reducing IL-6 production postoperatively.
诸如食管切除术等大手术会激活炎症反应和凝血系统，这种激活分别以炎症细胞因子的释放和抗凝血酶III（AT-III）的减少为特征。据报道，术前给予糖皮质激素可抑制大手术后循环细胞因子水平。
共有28例患者接受了食管癌食管切除术；其中14例在麻醉诱导时静脉注射10mg/kg甲泼尼龙，14例作为对照。在手术前、手术结束时以及术后第1、3、5和7天测量肿瘤坏死因子-α（TNF-α）、白细胞介素6（IL-6）、多形核白细胞（PMN）弹性蛋白酶、凝血酶-抗凝血酶III复合物（TAT）、AT-III和白蛋白的循环水平。
两组患者食管切除术后TNF-α、IL-6和TAT水平均显著升高。AT-III和白蛋白分别在术后第1天和第3天降至最低水平。甲泼尼龙治疗有效抑制了TNF-α和IL-6的升高以及AT-III和白蛋白的降低，但未抑制PMN弹性蛋白酶和TAT水平的升高。AT-III、IL-6和白蛋白水平之间存在显著相关性。
这些结果表明，甲泼尼龙预处理通过减少术后IL-6的产生减轻了AT-III的降低。
