天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (10): 1036-1039.doi: 10.11958/20170497

• 临床研究 • 上一篇    下一篇

先天性心脏病合并肺动脉高压患者围术期 IL-17 水平的变化

凡小庆，王瑞婷，柴小青，王德龙，贺克强   

  1. 安徽省立医院麻醉科（邮编 230001）
  • 收稿日期:2017-04-20 修回日期:2017-08-23 出版日期:2017-10-15 发布日期:2017-10-13
  • 通讯作者: 凡小庆 E-mail:15055701159@163.com
  • 作者简介:凡小庆（1988），女，硕士，住院医师，主要从事体外循环肺损伤临床研究
  • 基金资助:
    安徽省科学技术厅公益性项目

Observation of IL-17 levels of perioperative period in congenital heart disease patients with pulmonary hypertension

FAN Xiao-qing, WANG Rui-ting, CHAI Xiao-qing, WANG De-long, HE Ke-qiang   

  1. Department of Anesthesiology, Anhui Provincial Hospital, Hefei 230001, China
  • Received:2017-04-20 Revised:2017-08-23 Published:2017-10-15 Online:2017-10-13
  • Contact: Xiao QingFAN E-mail:15055701159@163.com

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摘要： 目的 探讨成人先天性心脏病合并肺动脉高压患者围手术期血浆白细胞介素-17（IL-17）水平变化的规 律及意义。方法 择期体外循环（CPB）下行先天性心脏病修补术患者 40 例，根据肺动脉收缩压（PASP）分为非肺动 脉高压组（Ⅰ组，PASP<30 mmHg）以及肺动脉高压组（Ⅱ组，PASP≥30 mmHg）。于麻醉诱导前（T1）、CPB 即刻（T2）、停 CPB 后 30 min（T3）、术后 6 h（T4）、术后 24 h（T5）以及术后 7 d（T6）采集动脉血标本，检测血浆 IL-17 的水平，同时测定 前 5 个时点患者的动脉氧分压［p（O2）］及二氧化碳分压［p（CO2）］，计算氧合指数（OI）及肺泡-动脉氧分压差 （AaDO2）。结果 整个围手术期Ⅱ组血浆 IL-17 水平高于Ⅰ组（P < 0.05），且 2 组 IL-17 水平均于 T3期达到峰值，之 后降低；此时 2 组 OI 降低，而 AaDO2却明显升高。术后 24 h（T5），与Ⅰ组相比，Ⅱ组 OI 下降，AaDO2出现升高（P < 0.05）。结论 高水平的 IL-17 在先天性心脏病肺动脉高压的形成中起一定促进作用，可能参与了 CPB 后的肺损 伤，可作为评估病情的指标。

关键词: 心脏缺损, 先天性, 高血压, 肺性, 白细胞介素 17, 体外循环

Abstract: Objective To discuss the changes and significance of interleukin- 17 (IL-17) in perioperative period of congenital heart disease patients with pulmonary hypertension. Methods A total of forty patients with congenital heart disease underwent cardiopulmonary bypass (CPB) were included in this study. According to the pulmonary artery systolic pressure (PASP), patients were divided into non- pulmonary hypertension group (group Ⅰ, PASP < 30 mmHg) and pulmonary hypertension group (group Ⅱ, PASP≥30 mmHg). Blood samples were taken before anesthesia (T1), start CPB (T2), 30 min after CPB (T3), 6 h (T4), 24 h (T5) and 7 d (T6) after operation. The concentration of IL-17 was detected by ELISA. Arterial oxygen partial pressure [p(O2)] and arterial carbon dioxide partial pressure [p(CO2)] during the first five time points were recorded. Oxygen index (OI) and alveolar arterial oxygen tension difference (AaDO2) were calculated. Results The plasma IL-17 levels in perioperative period were significantly higher in group Ⅱ than those of group Ⅰ (P < 0.05). The highest concentration of IL-17 emerged at T3, then decreased gradually in both groups. At this time point, the OI decreased, and AaDO2 increased significantly in both groups. Compared with groupⅠ, the OI decreased, while AaDO2 increased at T5 in groupⅡ (P <0.05). Conclusion The high level of IL-17 promotes the formation of pulmonary hypertension in congenital heart disease and leads to the lung injury during CPB, which can be used as a clinical monitoring indicator of evaluating severity.

Key words: heart defects, congenital, hypertension, pulmonary, interleukin-17, extracorporeal circulation