Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection
Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection
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DOI：
10.1016/j.jss.2005.10.025
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发表时间：
2006-06-15
影响因子：
2.2
通讯作者：
Miyazaki, M
中科院分区：
文献类型：
--
作者：
Kimura, F;Shimizu, H;Miyazaki, M
背景体液介质可能参与手术后并发症的发病机制。本研究的目的是评估肝切除术后循环细胞因子，趋化因子和应激激素的术后反应，以及它们对术后感染并发症和器官功能障碍的影响。采用免疫组化法检测128例肝切除术患者围术期血浆白细胞介素（IL）-6、IL-10、IL-4、IL-8、巨噬细胞趋化蛋白（MCP）-1、皮质醇、巨噬细胞移动抑制因子（MIF）和瘦素水平。43例患者发生术后感染，11例发生感染相关器官功能障碍。术后除IL-4外，所有介质的血浆水平均升高。术后器官功能不全组IL-6、IL-10、IL-8、MCP-1、皮质醇和瘦素水平均显著高于无器官功能不全组（P < 0.05）。然而，术后AUF水平不受术后感染或器官功能障碍的影响。血浆IL-6、IL-10、IL-8和MCP-1水平与手术时间（P < 0.0001）或出血量（P <0.0001）呈正相关，且黄疸肝患者更高（P < 0.05）。单因素Logistic回归分析显示，IL-6、IL-10、IL-8和MCP-1升高、高龄、失血量大、手术时间长、肝缺血时间长、肝切除术后感染与术后感染显著相关（P < 0.05）。多因素分析显示，IL-6和IL-10是术后感染的显著易感因素（P < 0.05），失血量和IL-6是术后器官功能障碍的显著易感因素（P < 0.01）。提示肝切除术后IL-6、IL-10、IL-8、MCP-1、皮质醇和瘦素的释放与术后感染和器官功能障碍有关，其中IL-6和IL-10的释放与术后并发症密切相关。(c)2006年爱思唯尔公司All rights reserved.
Background. Humoral mediators are potentially involved in the pathogenesis of postoperative complications following surgery. The aim of the present study is to evaluate the postoperative responses of circulating cytokines, chemokines, and stress hormones following liver resection, and their effects on postoperative infectious complications and organ dysfunction.Patients and methods. Perioperative plasma concentrations of interleukin (IL)-6, IL-10, IL-4, IL-8, macrophage chemoattractant protein (MCP)-1, cortisol, macrophage migration inhibitory factor (MIF), and leptin were measured by immunoassays in 128 consecutive patients undergoing liver resection.Results. Forty-three patients had postoperative infection and 11 had infection-related organ dysfunction. Plasma levels of all mediators except for IL-4 increased postoperatively. Postoperative levels of IL-6, IL-10, IL-8, MCP-1, cortisol, and leptin were significantly higher in patients with organ dysfunction than in those without organ dysfunction (P < 0.05). However, postoperative AUF levels were not affected by postoperative infection or organ dysfunction. Plasma levels of IL-6, IL-10, IL-8, and MCP-1 were positively correlated with operation time (P < 0.0001) or blood loss (P < 0.0001), and higher in patients with jaundiced liver (P < 0.05). In univariate logistic regression analyses, elevated IL-6, IL-10, IL-8, and MCP-1, advanced age, large volume of blood loss, long operation time, long hepatic ischemia time, and major liver resection were significantly correlated with postoperative infection (P < 0.05). In multivariate analyses, IL-6 and IL-10 were significant predisposing factors for postoperative infection (P < 0.05), and blood loss and IL-6 for organ dysfunction (P < 0.01).Conclusions. These results suggest that IL-6, IL-10, IL-8, MCP-1, cortisol, and leptin are released after liver resection in response to surgical stress and correlated with postoperative infection and organ dysfunction, and that of these circulating mediators, IL-6 and IL-10, have a close relationship to the complications. (c) 2006 Elsevier Inc. All rights reserved.