Schroder J, Gallati H, Kremer B
Department of General and Thoracic Surgery, University of Kiel, Germany.
Hepatogastroenterology. 1998 Sep-Oct;45(23):1807-12.
BACKGROUND/AIMS: This study was conducted to evaluate the association of tumor necrosis factor-a and soluble receptors as known antagonists in liver surgery with regard to ischemia and reperfusion.
Preoperative and perioperative changes of TNF, soluble TNF receptor I and II as well as IL-6 were evaluated in twelve patients with partial liver resection. Before liver ischemia and after reperfusion, the levels were measured in the portal and hepatic vein, as well as systemically. Ten patients with gastrectomy and lymphadenectomy as another major abdominal operation and eight healthy volunteers served as the control groups.
Uncomplicated liver resections were associated with a prolonged and significantly increased release of soluble receptors until the third (for soluble receptor I) or the fifth postoperative day (for soluble receptor II). No tumor necrosis factor immunoreactivity could be detected, except in one patient with postoperative sepsis. The pattern of interleukin-6 immunoreactivity during liver resection was characterized by a delayed peak on day 2 (p<0.01 vs preop), compared to an early peak after 8 hours in control patients undergoing gastrectomy (p<0.05 vs preop). Liver resection elicits a release of interleukin-6 and soluble receptors without ischemia/reperfusion-induced effects. A strong correlation of the soluble receptors with interleukin-6 (p<0.01) could be detected in liver resection and gastrectomy.
Uncomplicated liver resections were associated with a prolonged and increased release of soluble tumor necrosis factor receptors while no immunoreactivity could be detected. The strong correlation of soluble receptors with interleukin-6 may suggest an important role in the acute phase response of major operations.
背景/目的：本研究旨在评估肿瘤坏死因子-α及其可溶性受体（已知的拮抗剂）在肝脏手术中与缺血再灌注的相关性。
对12例接受部分肝切除术的患者术前及围手术期肿瘤坏死因子（TNF）、可溶性TNF受体I和II以及白细胞介素-6（IL-6）的变化进行评估。在肝脏缺血前及再灌注后，于门静脉、肝静脉及全身测定这些指标水平。10例接受胃切除术及淋巴结清扫术（另一项主要腹部手术）的患者和8名健康志愿者作为对照组。
无并发症的肝切除术与可溶性受体的释放延长及显著增加相关，直至术后第3天（可溶性受体I）或第5天（可溶性受体II）。除1例术后发生脓毒症的患者外，未检测到肿瘤坏死因子免疫反应性。肝切除术中白细胞介素-6免疫反应性的模式特点是在术后第2天出现延迟峰值（与术前相比，p<0.01），而接受胃切除术的对照患者在术后8小时出现早期峰值（与术前相比，p<0.05）。肝切除术可引发白细胞介素-6和可溶性受体的释放，且无缺血/再灌注诱导的效应。在肝切除术和胃切除术中可检测到可溶性受体与白细胞介素-6之间存在强相关性（p<0.01）。
无并发症的肝切除术与可溶性肿瘤坏死因子受体的释放延长及增加相关，而未检测到免疫反应性。可溶性受体与白细胞介素-6之间的强相关性可能提示其在大手术急性期反应中起重要作用。
