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

1998年，我们在冈山大学医院成功进行了活体供体肺叶移植（LDLLT），这是日本第一例肺移植（LT）。肝移植急性期死亡率高于心脏移植。在1998年10月至2007年2月期间，我们对55名患有各种肺部疾病的危重患者进行了肝移植。51名受者目前存活，随访期为1至120个月。肺再灌注损伤（RLI）是导致死亡的主要原因，治疗方法尚未确定。在日本，肝移植通常采用体外循环（CPB）。RLI发生在肺移植术后，是围手术期的主要并发症。CPB可加重受体炎症反应，CPB后移植物再灌注可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。本研究的目的是测定行LDLLT手术合并CPB患者术中血浆中关键细胞因子和多态核弹性酶（PMN-E）的水平。芬太尼50 ~ 100μg/kg，泮库溴铵麻醉。在CPB前、CPB中（再灌注前30分钟）和CPB后2小时（LT手术后）3个时间点采集动脉血。CPB在中低温下进行无搏动血流，使用微孔膜氧合器和牛肝素抗凝。患者在CPB期间再灌注供体肺叶前静脉注射甲基强的松龙（30mg /kg）。肿瘤坏死因子α (TNF-α)、白细胞介素6 （IL-6）和PMN-E浓度测定采用CLEIA和乳胶凝集法（MBC，东京，日本）。在CPB期间和之后，LT患者表现出IL-6和PMN-E的显著升高。CPB后IL-6产量显著增加。缺血和CPB时间与IL-6和PMN-E水平无相关性。我们的数据表明，CPB可触发炎症细胞因子和介质的产生，并且CPB后肺移植物的再灌注可加速IL-6的产生。为预防肺缺血再灌注损伤，降低IL-6水平可能有利于。行LDLLT伴CPB手术。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