Serum tumor necrosis factor α, Interleukin-6, and polymorphonuculear elastase levels during lung transplantation with cardiopulmonary bypass

我们于1998年在冈山大学医院成功地进行了活体肺移植，这是日本第一例肺移植。肝移植急性期病死率高于心脏移植。1998年10月至2007年2月，我们对55例患有各种肺部疾病的危重患者进行了肺移植。目前有51名受助者在世，随访期为1至120个月。死亡的主要原因是再灌注肺损伤(RLI)，治疗方法尚未确定。在日本，它通常采用体外循环(CPB)。RLI发生在肺移植后，是围手术期的主要并发症。CPB可加重受体的炎症反应，CPB后移植物再灌注可能加重缺血再灌注损伤。炎症介质在再灌注损伤的调节中起重要作用。本研究的目的是测量术中关键的c-…水平。体外循环下LDLLT患者血浆中细胞因子和中性粒细胞弹性蛋白酶的升高。麻醉诱导采用芬太尼50~100μg/kg和潘库溴铵。分别于CPB前、CPB中(再灌注前30min)、CPB后2小时(LT后)采集动脉血。使用微孔膜氧合器和牛肝素抗凝，在中低温下进行非脉动血流体外循环。供叶再灌注前CPB期间给予甲基强的松龙(30 mg/kg)静脉滴注。用胶乳凝集法和化学发光免疫分析法检测肿瘤坏死因子α、白介素6和中性粒细胞E的浓度。体外循环期间和术后LT患者IL-6和PMN-E均显著升高。体外循环后IL-6产生明显增加。缺血时间和体外循环时间与IL-6和PMN-E水平无相关性。我们的数据提示CPB可触发炎性细胞因子和介质的产生，而CPB后肺再灌注可加速IL-6的产生。为预防缺血再灌注性肺损伤，降低IL-6水平可能是有益的。在体外循环下进行LDLLT手术。较少

We have succeeded a living-donor lober lung transplantation (LDLLT) at Okayama University Hospital in 1998, which was the first lung transplantation (LT) in Japan. The acute phase mortality rate of LT is higher than that of heart transplantation. Between October 1998 and February 2007, we performed LT in 55 critically ill patients with various lung diseases. 51 recipients are currently alive, with a follow-up period of 1 to 120 months. A major cause of the death is reperfusion lung injury (RLI) and the treatment has not been established. LT is generally performed with the use of cardiopulmonary bypass (CPB) in Japan. RLI occurs following lung transplantation, and is a major perioperative complication. CPB exacerbates inflammatory response in recipient and reperfusion of grafts after CPB may deteriorate ischemia-reperfusion injury. Inflammatory mediators play an important role in the modulation of reperfusion injury. The purpose of this study is to measure intraoperative levels of key c … More ytokines and polymorphonuclear elastase (PMN-E) in plasma in patients undergoing LDLLT surgery with CPB. Anesthesia was induced with fentanyl 50-100μg/kg and pancuronium. Arterial blood sample were collected at 3 time points, before CPB, during CPB (30 minutes before reperfusion), and 2 hour after CPB (after LT procedure). CPB was performed with nonpulsatile flow under moderate hypothermia, using a microporous membrane oxygenator and bovine heparin anticoagulation. Patients were treated with methylprednisolone (30 mg/kg) IV during CPB just before reperfusion of donor lobes. Tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and PMN-E concentrations were measured by CLEIA and latex agglutination method (MBC, Tokyo, Japan). LT patients demonstrated significant elevations of IL-6 and PMN-E during and after CPB. IL-6 production increased significantly after CPB. Ischemic and CPB time did not correlate with IL-6 and PMN-E levels. Our data suggest that production of inflammatory cytokines and mediators are triggered by CPB and that production of IL-6 is accelerated by reperfusion of lung grafts after CPB. In order to prevent ischemia-reperfusion lung injury, it may be beneficial to reduce IL-6 levels when. LDLLT surgery with CPB is performed. Less