CAJ | 학술논문

目的研究白细胞介素-8(IL-8)在围手术期的变化及其与基因多态性关系,探讨心脏手术后炎性反应与预后的相关性.方法术前分析IL-8(-251A>T)基因多态性.并于术前、术后4 h、24 h、72 h获取血液标本检测细胞因子.同时记录手术情况及对应时间点患者肌钙蛋白T(TnT)、肌酸激酶同工酶(CKMB)和血肌酐等生化指标.结果 145名患者首次接受择期非体外循环下冠状动脉旁路移植术,术后患者血浆IL-8水平上升,术后4 h水平最高(18.0[8.4,37.1]ng/L,P=0.000),术后3 d已下降至接近术前水平.其中-251AA基因型患者术后4 h IL-8水平产量升高(33.1[16.6,49.5]ng/L)(P=0.035).IL-8-251AA基因型患者,TnT和CKMB水平于术后4 h高于AT和TT基因型患者(TnT:0.53[0.43,4.92]ng/ml,P=0.037;CKMB:41.5[28.8,65.5]U/L,P=0.025);AA基因型患者血肌酐水平于术后24 h升高(93.1[76.4,121.5]μmol/L,P＝0.021).手术后呼吸机使用>1 d或术后住院时间>14 d患者,术后4 h IL-8水平升高(P=0.036,0.038).应用Logistic回归方法对术后出现呼吸机使用>1 d,术后住院>14 d等危险因素进行回归分析发现,IL-8-251AA患者呼吸机使用>1 d(OR＝11.80,95% CI:1.87～74.48),术后住院>14 d(OR=38.00,95% CI:4.15～347.87)风险增加.结论非体外循环下冠状动脉旁路移植术会引起机体炎性反应.IL-8-251AA基因型患者术后炎性反应程度及预后风险增加,手术后炎性反应程度和预后与遗传背景有关.
목적 연구백세포개소-8(IL-8)재위수술기적변화급기여기인다태성관계,탐토심장수술후염성반응여예후적상관성.방법 술전분석IL-8(-251A>T)기인다태성.병우술전、술후4 h、24 h、72 h획취혈액표본검측세포인자.동시기록수술정황급대응시간점환자기개단백T(TnT)、기산격매동공매(CKMB)화혈기항등생화지표.결과 145명환자수차접수택기비체외순배하관상동맥방로이식술,술후환자혈장IL-8수평상승,술후4 h수평최고(18.0[8.4,37.1]ng/L,P=0.000),술후3 d이하강지접근술전수평.기중-251AA기인형환자술후4 h IL-8수평산량승고(33.1[16.6,49.5]ng/L)(P=0.035).IL-8-251AA기인형환자,TnT화CKMB수평우술후4 h고우AT화TT기인형환자(TnT:0.53[0.43,4.92]ng/ml,P=0.037;CKMB:41.5[28.8,65.5]U/L,P=0.025);AA기인형환자혈기항수평우술후24 h승고(93.1[76.4,121.5]μmol/L,P＝0.021).수술후호흡궤사용>1 d혹술후주원시간>14 d환자,술후4 h IL-8수평승고(P=0.036,0.038).응용Logistic회귀방법대술후출현호흡궤사용>1 d,술후주원>14 d등위험인소진행회귀분석발현,IL-8-251AA환자호흡궤사용>1 d(OR＝11.80,95% CI:1.87～74.48),술후주원>14 d(OR=38.00,95% CI:4.15～347.87)풍험증가.결론 비체외순배하관상동맥방로이식술회인기궤체염성반응.IL-8-251AA기인형환자술후염성반응정도급예후풍험증가,수술후염성반응정도화예후여유전배경유관.
Objective To observe the change of interleukin-8(IL-8) during perioperative period, and to define whether the increase of IL-8 in response to cardiac surgery is related to the presence of a certain allele in a functional polymorphism. To explore the relationship between postoperative inflammation and clinical outcome. Methods One hundred and forty-five patients undergoing selective off-pump coronary artery bypass (OPCAB) for the first time were enrolled. The IL-8 (-251A >T) polymorphisms were analyzed by using polymerase chain reaction (PCR) and gene sequencing. The plasma levels of cytokine, troponin T (TnT). creatine kinase-MB (CK-MB) and creatinine (Cr) were measured before and 4, 24 and 72 hours after operation by suspension array system. Results After surgery, the IL-8 concentration increased and reached the highest level at 4 hours after surgery [18.0 (8.4, 37.1) ng/L, P = 0.000], and then it decreased to the preoperative level at 3 days after surgery. Four hours after surgery, the patients with IL-8-251 AA homozygous genotype had higher concentration of IL-8 C33.1 (16.6, 49.5) ng/L, P =0.0353. They had higher TnT and CK-MB levels than patients homozygous for AT and TT genotype 4 hours after surgery [TnT:0.53 (0.43, 4.92) ng/ml, P = 0.037; CK-MB: 41.5 (28.8, 65.5) U/L, P=0.025], and patients homozygous for AT genotype had higher Cr level 24 hours after surgery C93.1 (76.4, 121.5) μmol/L, P = 0. 021]. The patients who underwent ventilation for more than 1 day or post-operative hospital stay for more than 14 days had higher IL-8 levels (P=0.036, 0.038). IL-8-251AA genotype was an independent risk factor for patients undergoing ventilation for more than 1 day (OR=11.80, 95% CI: 1.87-74.48) and post-operative hospital stay for more than 14 days (OR=38.00, 95% CI:4.15-347. 87) . Conclusions OPCAB results in postoperative inflammatory response. IL-8-251AA genotype is associated with longer mechanical ventilation and hospital staying. Genetic background might alter the extent of inflammatory response and relate to postoperative prognosis. 、