半肝切除对血清细胞因子及甲状腺激素和胰岛素水平的影响

目的探讨半肝切除对白细胞介素-2(IL-2)、肿瘤坏死因子(TNF)、胰岛素样生长因子(IGF)、甲状腺激素(TT3、TT4)、胰岛素(INS)的影响。方法选60只健康雄性大白兔,随机分为手术切除左半肝脏组和仅行开腹、关腹术的对照组,每组30只。分别于术前1d及术后24h、1周和4周取外周静脉血,监测血清IL-2、TNF、IGF、TT3、TT4、INS的变化。结果半肝切除组术后24hIL-2显著升高(P<0.01),术后1周降至低于术前水平,以后逐渐增加,术后4周接近术前水平;术后24hTNF略有下降(P<0.05),以后逐渐升高,于术后4周显著高于对照组(P<0.01)。TT3、TT4术后24h明显降低,1周逐渐回升(P均<0.01),TT3较TT4回升幅度大,术后4周均接近术前水平;术后24hIGF、INS明显升高,1周时升至最高水平(P均<0.01),术后4周恢复到术前水平。对照组几乎无变化。结论半肝切除术后出现正常甲状腺病态综合征和高胰岛素反应;IL-2降低与手术打击创伤后免疫功能低下有关;TNF增高与肝细胞的凋亡、坏死和炎症反应相关;IGF则与肝细胞的再生有关。

Influence of semi-hepatectomy on levels of cytokine, insulin and thyroxin in serum

Objective To explore the influence of semi-hepatectomy on levels of interleukin-2 (IL-2), tumor necrosis factor (TNF), insulin growth factor (IGF), thyroxin (TT3, TT4) and insulin(INS)in serum. Methods Sixty healthy male rabbits were randomized into two groups: semi-hepatectomy group and control group, and the latter group received sham operation. Levels of serum IL-2, TNF, IGF, TT3, TT4 and INS were determined 1 day before opetation and 24 hours, 1 week and 4 weeks after operation. Results The IL-2 level in semi-hepatectomy group was elevated significantly at 24 hours after operation (P<0.01), then dropped to the level lower than that before the operation 1 week after operation, and then increased gradually to preoperative level 4 weeks later.The levels of TNF lowered 24 hours after operation (P<0.05), then began to rise, and became significantly higher than control group 4 weeks after operation (P<0.01). The levels of TT3 and TT4 significantly lowered 24 hours after operation and recovered gradually 1 week after operation (both P<0.01) until to the preoperative levels 4 weeks later. TT3 recovered especially significantly. The level of INS and IGF elevated significantly 24 hours after operation and reached its peak level 1 week after operation (both P<0.01),then recovered to the preoperative level 4 weeks later. The various mediators showed no changes in control group. Conclusion Sick hypothyroid syndrome and hyperinsalinism appeared after semi-hepatectomy.Decrease in IL-2 level contributes to lowered immunity after operative trauma, and elevation of TNF level contributes to apoptosis of hepatocytes, necrosis and inflammation. An elevation of IGF level contributes to regeneration of liver cells.