胸部恶性肿瘤患者开胸手术前后血清内脏蛋白和炎性细胞因子水平变化的意义

目的：探讨本文患者胸部恶性肿瘤手术前后血清内脏蛋白和炎性细胞因子水平的变化及其测定意义。方法：血清前白蛋白（prealbumin，PRE）、转铁蛋白（transferrin，Tf）和视黄醇结合蛋白（retinal-bindingpro-tein，RBP）三项内脏蛋白测定采用免疫散射比浊法；IL-6、IL-8、TNF-仪三项炎性细胞因子测定采用放射免疫分析，另以32人作为正常对照组。结果：血清内脏蛋白指标水平显示，术前24h组三项蛋白水平略低于正常对照组，但无显著性差异（P〉0．05），术后2h组其水平则均显著低于正常对照组和术前24h组（P〈0．05），术后24h组水平下降更甚（P〈0．01），两手术组间比较后者更低，但无统计学差异（P〉0．05）。血清炎性介质水平则显示术前24h组IL-6和IL-8二项细胞因子水平略高于正常对照组，但无显著性差异（P均〉0．05），TNF-a水平则高于正常对照组，有显著性差异（P〈0．05），术后2h组和术后24h组水平均分别显著高于正常对照组和术前24h组（P〈0．05，P〈0．01），两手术组间比较术后24h组水平显著高于术后2h组（P均〈0．05）。结论：本文患者血清六项血清指标的变化证实患者存在明显的围手术期应激反应；提醒临床应在整个手术期充分做好各种应对预案。

Clinical Significance of Changes on Serum Visceral Protein and Inflammatory Cytokines Levels Both Before and After Chest Operation in Patients with Thoracic Malignant Tumors

Objective To explore the changes of related serum visceral protein and inflammatory mediators levels both before and after chest operation on thoracic malignancies and clinical significance of determination. Methods Serum contents of PRE , Tf,RBP levels were measured with immuno nephelometry and serum IL-6 ,IL-8 or TNF-α levels With radioimmunoassay beth before and after operation on 30 chest operation on thoracic malignant tumors patients as well as in 32 normal persons served as control group. Results The semn levels of these three visceral protein in the patients 24h before operation showed slightly lower, but not significantly higher than those in normal control group（P 〉 0.05 ）, 2h artery surgery, the serun levels all decreased more and proved significantly differ- ences than that normal control group（ all P 〈 0.05 ）, and serum levels of these three visceral protein expressed decreased farther and by 24h, indicated remarkably differences than the normal control group（ all P 〈0.01 ）. Compared with two groups of operation, and serum levels of three visceral protein decreased farther in 24h postoperatively group than the 2h postoperatively group. The changes of three serum inflammatory medium level results showed, these serum levels of cytokine presented all obviously increased in 2h postoperatively and 24h postoperatively group than those in normal control group（P 〈0.05, P 〈0.01 ）, but these serum level of inflammatory media- tors indicated increased more significantly in 24 h after the operation group, but no significant differences higher than those in 2h post- operatively group （P 〉 0.05）. Conclusion Stress reaction proved very obvious in these patients perioperative period with significantly higher serum levels of six markers, according to this dams, and to remind the clinical should be fully prepared to deal with a variety of plans in the whole operation period.