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Chinese Journal of Blood Purification ›› 2005, Vol. 4 ›› Issue (9) : 500-503.

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Abstract

Objective To observe the dynamic changes of plasma pro-inflammatory and anti-inflammatory cytokines during open-heart surgery with cardiopulmonary by pass(CPB) and their relationships with postoperative renal and respira-tory dysfunction. Methods Blood samples from 15 patients undergoing valve replacement with CPB were analysed for tumor necrosis factor α (TNF-α, interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10), interleukin 1 receptor antagonist (IL-1ra) and C- reactive protein (CRP). Results ①The plasma levels of TNF－α、IL－6、IL－8、CRP、IL－10 and IL-1ra were significantly elevated after CPB started (P<0.05 all). Peak values of TNF－αand IL－6 were (12.67±2.78) pg/ml and (133.71±29.13) pg/ml respectively at the end of CPB. Peak values of IL－8 was (101.31±31.82) pg/ml at two hours after the end of CPB. Plasma CRP was significantly increased and reached peakvalue of (141.14±27.81) mg/L at two days after the operation. There was a close correlation between the level of IL－10 and CRP (r=0.452, P<0.01). ② Acute renal failure occurred in 2/15 patients one day after the operation, the urinary protein excretion increased in 9/15 patients and all patients showed increased urinary N-acetyl-β D-glycosaminidase (NAG). The levels of urinary NAG was correlated with plasma level of TNF－α (r=0.501, P <0.01), and a negative correlation could be seen between creatinine clearance (Ccr) and CRP levels (r=-0.404, P <0.05). ③Plateau airway pressure(PPlateau) and Peak airway pressure (PPeak) increased to peak value at 60 min after the end of CPB. The PPeak was correlated with plasma TNF－α(r=0.472, P<0.01). Conclusions Plasma pro-inflammatory and anti-inflammatory cytokines were significantly elevated during CPB. The levels of pro-inflammatory cytokines levels were closely associated with lung and kidney dysfunction after CPB. Decreasing the levels of pro-inflammatory cytokines might be a potential intervention for CPB-induced lung and kidney injury.