冠状动脉搭桥术后血浆可溶性Fas及其配体的变化

目的比较在心肺转流（CPB）或非CPB下冠状动脉搭桥术（cABG）后可溶性Fas（sFas）和可溶性Fas配体（sFasL）的血浆浓度变化。方法19例病人分别在CPB（CPB组，n=9）或非CPB（非CPB组，n=10）下行择期cABG。术前、术毕和术后取血测定白细胞介素-6（IL-6）、中性粒细胞弹性蛋白酶、sFas、sFasL血浆浓度。结果术毕、术后4h的IL-6和术毕、术后4、12h的中性粒细胞弹性蛋白酶非CPB组明显低于CPB组（P〈0．05或P〈0．01）。CPB组的sFas在术后4、12h明显升高（P〈0．05或P〈0．01），非CPB组在术后12h明显升高（P〈0．01），术后24h恢复至术前水平。两组的sFasL在术毕和术后4、12h均明显升高（P〈0．05或P〈0．01），术后24h恢复至术前水平；其中术后12h非CPB组明显低于CPB组（P〈0．05）。结论CPB或非CPB下行cABG均导致sFas和sFasL血浆浓度升高，但CPB的应用使sFasL血浆浓度升高得更多。sFasL血浆浓度可反映机体炎性反应的程度。

Changes of plasma soluble Fas and soluble Fas ligand in patients undergoing coronary artery bypass surgery with or without cardiopulmonary bypass

Objective To compare the changes of plasma concentrations of soluble Fas(sFas) and soluble Fas ligand (sFasL) in patients undergoing coronary artery bypass grafting(CABG) with or without cardiopulmonary bypass (CPB). Methods Elective CABG was performed in 19 patients with CPB(CPB group,n=9) or without CPB (non-CPB group,n=10). Blood samples were taken for detecting interleukin(IL)-6,neutrophil elastase,sFas and sFasL before surgery,at the end of surgery,and at various intervals after surgery. Results The plasma concentrations of IL-6 and neutrophil elastase were significantly lower in non-CPB group than those in CPB group (for IL-6,P<0.05 at the end of surgery and at 4 h after surgery,for neutrophil elastase,P<0.01 or P<0.05 at the end of surgery and at 4,12 h after surgery,respectively). The plasma concentration of sFas of CPB group increased significantly at 4 and 12 h after surgery (P<0.05 or P<0.01) and that of non-CPB group increased significantly at 12 h after surgery (P<0.01),while all of them recovered to the baseline at 24 h after surgery. The plasma concentration of sFasL of both groups increased significantly at the end of surgery and at 4,12 h after surgery (P<0.05 or P<0.01) and recovered to the baseline at 24 h after surgery. It was significantly lower in non-CPB group than that in CPB group at 12 h after surgery (P<0.05). Conclusion CABG with or without CPB caused significant elevation of plasma concentrations of sFas and sFasL. However,use of CPB led to more significant elevation of plasma concentration of sFasL. Plasma level of sFasL could indicate the degree of systemic inflammatory response induced by CABG with or without CPB.