体外循环下瓣膜置换术后急性呼吸窘迫综合征患者血清IGF-1 IL-6 IL-10的表达及临床意义

doi:10.3969/j.issn.1006-6233.2022.12.016

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摘要 目的: 探讨体外循环下瓣膜置换术后急性呼吸窘迫综合征患者血清IGF-1、IL-6、IL-10浓度水平及其与预后的相关性分析。方法: 选取我院2016年12月至2020年12月行体外循环下瓣膜置换手术患者211例,依据患者术后是否发生急性呼吸窘迫综合征分为ARDS组和非ARDS组。分别于麻醉诱导后体外循环前、体外循环后2h、6h、12h、24h(记为T1-T5)采集患者动脉血气分析,计算氧合指数(oxygenation index,OI);并于T1~T5时刻采集患者静脉血,应用ELISA法测定血清IGF-1、IL-6及IL-10浓度,分析术后患者血清IGF-1、IL-6及IL-10的变化趋势及对术后急性呼吸窘迫综合征的影响。结果: ARDS组体外循环下瓣膜置换术后患者IGF-1、IL-6、IL-10血清浓度明显高于术前水平,且于术后24h内呈上升趋势;ARDS组患者术后12h、24h时IGF-1、IL-6、IL-10血清浓度较非ARDS组均明显升高(P<0.05)。ARDS组,将CPB下瓣膜置换术后24h时细胞因子浓度水平与术后24h时OI进行Pearson相关性分析,结果发现CPB术后24h时IGF-1浓度与术后24h时OI有相关性(r=0.808,P<0.001);CPB术后24h时IL-6浓度与术后24h时OI有相关性(r=0.737,P=0.001)。结论: 体外循环下瓣膜置换术后出现急性呼吸窘迫综合征患者IGF-1、IL-6、IL-10血清浓度水平较未出现者明显升高,IGF-1、IL-6、IL-10血清浓度与体外循环瓣膜置换术后急性呼吸窘迫综合征的发生发展有密切关系,对预测体外循环下瓣膜置换术后并发急性呼吸窘迫综合征有一定指导意义。

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关键词 ：体外循环, 急性呼吸窘迫综合征, 胰岛素样生长因子-1, 白细胞介素-6, 白细胞介素-10, 瓣膜置换

Abstract：Objective: To investigate the levels of serum IGF-1, IL-6, IL-10 in patients with acute respiratory distress syndrome after valve replacement under extracorporeal circulation and their correlation with prognosis. Methods: 211 patients who underwent valve replacement under extracorporeal circulation in our hospital from December 2016 to December 2020 were divided into ARDA group and non-ARDS group according to whether they developed acute respiratory distress syndrome after operation. Arterial blood gas analysis was collected after anesthesia induction and before extracorporeal circulation, 2h, 6h, 12h and 24h after extracorporeal circulation (recorded as T1~T5), and oxygenation index (OI) was calculated; the venous blood of patients was collected at T1-T5. The levels of IGF-1, IL-6 and IL-10 in serum were measured by ELISA. The change trends of IGF-1, IL-6 and IL-10 in serum and their effects on postoperative acute respiratory distress syndrome were analyzed. Results: The serum concentrations of IGF-1, IL-6 and IL-10 in patients with ARDS after valve replacement under extracorporeal circulation were significantly higher than those before operation, and showed an upward trend within 24 hours after operation; the serum concentrations of IGF-1, IL-6 and IL-10 in ARDS group were significantly higher than those in non ARDS group at 12 and 24 hours after operation (P<0. 05). In ARDS group, the concentration of cytokines at 24h after valve replacement under CPB and OI at 24h after operation were analyzed by Pearson correlation. The results showed that the concentration of IGF-1 at 24h after CPB was correlated with OI at 24h after operation (r=0. 808, P<0. 001); IL-6 at 24h after CPB was correlated with OI at 24h after CPB (r=0. 737, P=0. 001). Conclusion: The serum concentrations of IGF-1, IL-6 and IL-10 in patients with acute respiratory distress syndrome after valve replacement under extracorporeal circulation are significantly higher than those without extracorporeal circulation. The serum concentrations of IGF-1, IL-6 and IL-10 are closely related to the occurrence and development of acute respiratory distress syndrome after valve replacement under extracorporeal circulation, which has certain guiding significance for predicting the complication of acute respiratory distress syndrome after valve replacement under extracorporeal circulation.

Key words： Extracorporeal circulation Acute respiratory distress syndrome Insulin-like growth factor-1 Interleukin-6 Interleukin-10 Valve replacement

基金资助:河北省教育厅青年科学基金,(编号:QN2019131);河北省医学科学研究青年科技课题项目,(编号:20200182);河北省承德市科技计划项目,(编号:202006A048)

通讯作者: 冯增斌

引用本文:

陈永良, 薛晶, 卢黎明, 房大广, 田雪飞, 严晓丽, 冯增斌. 体外循环下瓣膜置换术后急性呼吸窘迫综合征患者血清IGF-1 IL-6 IL-10的表达及临床意义[J]. 河北医学, 2022, 28(12): 2026-2030.
CHEN Yongliang, et al. Expression and Clinical Significance of Serum IGF-1 IL-6 and IL-10 in Patients with Acute Respiratory Distress Syndrome after Valve Replacement under Extracorporeal Circulation. HeBei Med, 2022, 28(12): 2026-2030.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.12.016 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I12/2026