摘要
【目的】观察乌司他丁 (UTI)对肾移植缺血 /再灌注损伤中TNF α和IL 10的影响。【方法】择期肾移植患者 4 0例 ,ASAⅡ～Ⅲ级 ,随机分成对照组 (C组 ,n =2 0 ) ,不给UTI ;UTI组 (U组 ,n =2 0 ) ,均在术中经中心静脉给UTI 1万u/kg ,术后d1,d2 ,d3 各给UTI 1万u/kg。所有病人采用连续硬膜外麻醉。分别在麻醉给药前 (T1) ,切皮时 (T2 ) ,吻合血管开放时 (T3 ) ,手术结束时 (T4) ,术后d1(T5) ,术后d3 (T6)经中心静脉采血检测TNT α、IL 10水平。【结果】①两组病人移植肾肾血管开放后至术后 3d血中TNF α的水平较动脉开放前显著升高 (P <0 .0 1) ,在T3 时点剧升 ,至T4达高峰 ,在T6时点仍显著高于血管开放前水平 (P <0 .0 1) ;但U组升高的幅度在T3 、T4、T5、T6时点均比C组小 (P <0 .0 1)。②两组血中IL 10的水平在T3 、T4、T5都极显著性上升 (P <0 .0 1) ,至T4达峰值 ,在T5时开始回落 ,至T6时略高于吻合血管开放前水平(P <0 .0 5 ) ,但组间同时点比较差异无显著性 (P >0 .0 5 )。③术后C组有 1例发生急性肾小管坏死 (ATN) ,1例肺部感染 ,1例并发肝炎 ,而U组无此类病例出现。【结论】①肾移植围术期血中TNF α、IL 10显著增高 ,可能与肾缺血再灌注损伤有关。②UTI能有效减少肾移植围术期TNF α的释放 ,对缺血?
Objective The effects of UTI on cytokines TNF-α、IL-10 were studied during renal transplantation.Forty patients(ASAⅡ～Ⅲ) received selective renal transplantation wee randomly divided into two groups: control group(group C, n=20), ulinastatin was not used in the patients, and ulinastatin group (group U, n=20), UTI 10000 units per kilogram was given to each patient. All patients were received continuous epidural anesthesia. Blood samples were taken from the central vein before anesthesia(T 1): at the time of starting operation (T 2),at the time of releasing the anastomosed renal artery(T 3), at the time when operation was finished (T 4), on the first day after operation(T 5), on the third day after operation(T 6) for determination of plasma concentration of TNF-α, IL-10. ①The plasma concentration of TNF-α significantly more increased from the time of releasing the artery to the third day after operation than before releasing in both groups(P<0.01), and it rapidly increased at T 3, and to peak at T 4, still higher at T6 than before releasing(P<0.01), but increasing amplitude in group U was lower than that in group C at T 3、T 4、T 5、T 6, there was significant difference between the two groups(P<0.01).②The plasma levels of IL-10 at T 3、T 4、T 5、T 6were all higher than those at T 1 and T 2 (P<0.01) in two groups, and they all peaked at T4, then, they all fell again. They were higher than the baseline (P<0.05),but there was no significant difference between Group C and Group U(P>0.05).③After operation, one case had acute tubular necrosis (ATN), one case had lung inflammation, one case had hepatitis in group C, but no such complications in group U.[Conclusion]① The plasma concentrations of TNF-α、IL-10 increase significantly during renal transplatation,they may be related to renal ischemia-reperfusion injury.②Ulinastatin reduces the concentration of the some cytokines, and may have protective effects on renal ischemia-reperfusion ingury during renal transplatation.
出处
《医学临床研究》
CAS
2004年第7期712-715,719,共5页
Journal of Clinical Research
