非体外循环下冠脉搭桥术引起机体免疫平衡的变化研究

Surgery upsets the immune balance in patients undergoing OPCAB

关键词:  免疫平衡  非体外循环冠状动脉搭桥术  细胞因子

Key words:  immune balance  off-pump coronary artery bypass  cytokines

摘要:

目的 探讨非体外循环下冠状动脉搭桥术（off-pump coronary artery bypass，OPCAB）患者Th1/Th2和Th17/Treg平衡的变化。方法 以40例冠状动脉旁路移植术患者为研究对象。分别于麻醉前（T0）、切皮即刻（T1）、给肝素后5 min（T2）、给鱼精蛋白后5 min（T3）、手术结束时（T4）、术后1天（T5）、术后2天（T6）采血，测定肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）、白细胞介素-2（IL-2）、白细胞介素-4（IL-4）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、调节性生长因子-β（TGF-β）和白细胞介素-17（IL-17） 水平。结果 与T0相比，IFN-γ仅在T2时升高（P<0.01），而IL-2从T1持续升高至T4，TNF-α持续升高至T5。IL-4、IL-6、IL-10为Th2细胞因子，与T0相比，IL-6从T3开始升高，在T5时达到高峰，然后开始下降（均P<0.01）；IL-10和IL-4在T5时均显著升高（P<0.01），IL-4在T6时恢复正常，而IL-10在T6时仍升高。与T0相比，IL-17从T1开始升高，T4时达到高峰，IL-17水平在T6时仍未恢复到正常水平。TGF -β水平从T1开始下降，T2达到最低值，然后开始升高，但在T5和T6时仍低于T0。结论 手术破坏了机体的免疫平衡，导致Th1/Th2细胞向Th2细胞偏移，Th17/Treg细胞向Treg细胞偏移。

Abstract:

Objective The aim of this study was to explore the shift of Th1/Th2 and Th17/Treg balance in patients undergoing off-pump coronary artery bypass (OPCAB),and its clinical signiifcance. Methods The study involved 40 patients undergoing coronary artery bypass grafting. Blood samples were collected before anaesthesia (T0), skin incision(T1), 5 min after heparin administration(T2), 5 min after protamine administration(T3), surgery end time(T4), 1d after operation(T5) and 2d after operation(T6) to measure the levels of Th 1, Th 2, Th17 and Treg related cytokines, including tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin(IL)-2, IL-4, IL-6, IL-10, IL-17 and regulatory growth factor-β(TGF-β). Results For Th1 related cytokines, compared with T0, IFN-γ only increased at T2 (P<0.01 compared with T0), while IL-2 continuous increase until T4 and TNF-α continuous increase until T5. For Th2 related cytokines, IL-6 increased from T3, reached its peak at T5 and then began to decline (compared with T0, all P<0.01). Both IL-10 and IL-4 increased significantly at T5 (P<0.01 compared with T0), but IL-4 return to normal at T6, while IL-10 level still increased at T6. Th 17 related cytokine IL-17 increased from T1 and reached its peak at T4, and it did not return to normal at T6. Treg related cytokine TGF-β level decreased from T1 and reached its lowest value at T2, then began to increase at T5 and T6, though still lower than T0. Conclusion OPCAB would upset the immune balance, shift to Th2 and Treg, which could be caused by negative feedback to suppress the excessive inflammatory response.