紫绀型先心病围体外循环期血清EPO与TNF-α水平的观察

目的通过对紫绀型先天性心脏病和非紫绀型先天性心脏病患者围体外循环（CPB）期血清促红细胞生成素（EPO）、TNF-α水平的变化进行动态观察,探讨EPO对围体外循环期炎症因子水平可能的影响。方法 40例先天性心脏病患儿,其中紫绀组和非紫绀组各20例,均在中低温体外循环下接受心内直视手术,分别于麻醉后、CPB 30 min、CPB后2 h、CPB后24 h取血,测定并比较两组患者的血清EPO和TNF-α水平变化。结果紫绀组在CPB 30 min的血清TNF-α明显低于非紫绀组（P〈0.05）,在CPB后2 h、CPB后24 h的血清TNF-α高于非紫绀组（P〈0.01,P〈0.05）;术前血清EPO水平与CPB 30 min时血清TNF-α水平呈负相关（P〈0.05）。结论紫绀型先天性心脏病可能存在某种适应性改变,可在一定程度抑制CPB后的全身炎症反应,其抗炎症作用机制可能与EPO相关。

Observation on serum erythropoietin and tumor necrosis factor-alpha levels in perioperative period of cardiopulmonary bypass for cyanotic congenital heart disease

Objective To observe changes in serum erythropoietin（EPO） and tumor necrosis factor-alpha（TNF-α） levels in perioperative period of cardiopulmonary bypass（CPB） for cyanotic and acyanotic congenital heart disease and to discuss the possible anti-inflammatory effect of EPO in perioperative period of CPB.Methods Totally 40 patients with congenital heart disease were divided into cyanotic group and acyanotic group（n=20）.The levels of serum EPO and TNF-α were detected and determined before operation and at 30 minutes,2 hours,24 hours after CPB respectively after anesthesia and blood withdrawal.Results Serum TNF-α concentration was lower in cyanotic group at 30 minutes during CPB（P0.05）,but it was higher at 2 hours and 24 hours after CPB than that in acyanotic group（P0.01,P0.05）.Preoperative serum EPO concentration was negatively correlated with serum TNF-α concentration at 30 minutes during CPB（P0.05）.Conclusion There may be certain adaptive changes in cyanotic congenital heart disease,which may inhibit the systemic inflammatory response after CPB.The anti-inflammatory effect may correlate with EPO.