体外循环心脏手术中骨骼肌TNF-α和IL-8 mRNA表达的变化

目的 观察体外循环(CPB)心脏手术期间腹直肌TNF-α IL-8 mRNA表达的变化。方法 选择10例风湿性心脏病瓣膜置换术患者,分别于劈胸骨和关胸时在胸部正中切口下缘取腹直肌2g,用Tizol试剂提取总RNA,以RT-PCR测定TNF-α、IL-8 mRNA表达量,并分别在麻醉前、劈胸骨、CPB15 min、开放升主动脉后5 min、关胸时取静脉血以酶联免疫放射法测定TNFα和IL-8的含量。结果与劈胸骨时相比较,关胸时患者TNF-α、IL-8 mRNA表达明显增强(P<0.05),CPB 15min、开放升主动脉后5min、关胸时患者血TNF-α、IL-8水平明显高于麻醉前(P<0.05)。结论 体外循环中患者骨骼肌TNF-α、IL-8 mRNA表达明显升高,血TNF-α、IL-8含量也增高,这些变化可能在CPB期间全身炎性反应中起重要作用。

Changes in expression of TNF-α and IL-8 mRNA in skeletal muscle induced by cardiopulmonary bypass during cardiac surgery

Objective To investigate the changes in tumor necrosis factor-alpha ( TNF-a) and interleukin-8 (IL-8) mRNA in skeletal muscle during open heart surgery with cardiopulmonary bypass (CPB) . Methods Ten patients (4 male, 6 female) aged 35-62 yr undergoing valve replacement under CPB were enrolled in this study. Anesthesia was induced with midazolam, fentanyl and pancuronium and maintained with isoflurane-fentanyl and pancuronium. A specimen of rectus muscle of abdomen (2g) was taken while chest was being opened (baseline) and closed. Blood samples were obtained before anesthesia (T0), while chest was being opened (T1), 15 min after initiation of CPB (T2), 5 min after aortic unclampmg (T3) and while chest was being closed (T4) for determination of plasma TNF-a and IL-8 level using enzyme-linked immunosorbent assay technique. Results TNF-a and IL-8 mRNA expression in skeletal muscle were significantly increased while chest was being closed as compared with the baseline ( P < 0.05) . Plasma TNF-a and IL-8 levels were significantly higher at T2,3,4 than those at T0( P < 0.05) . Conclusion The significant increase in TNF-a and IL-8 mRNA expression in skeletal muscle and plasma TNF-a and IL-8 levels induced by CPB might play an important role in the systemic inflammatory response.