摘要：

PurposeTo evalute whether the production of interleukin 2 (IL 2), interlukin 6 (IL 6) and interlukin 10 (IL 10) from stimulated peripheal blood mononuclear cells (PBMC) was affected by coating extracorporeal circuits in patients undergoing cardiopulmonary bypass (CPB). In addition, postoperative clinical parameters were compared between patients with heparin-coated and uncoated CPB.DesignProspective, controlled in vivo/ex vivo study.ProcedureBlood samples were drawn immediately before, at the end and 24 hours after the end of CPB using either a conventional circuit (n=10) or a heparin-coated circuit (n=10) in patients undergoing CPB. Cytokine release on the supernatants of activated PBMC was detected. Cardiopulmonary parameters were measured before CPB, at ICU admission, 3 hours and 24 hours after ICU admission in both groups of patients. Statistical difference intragroups and between groups were investigated with the analysis of variance for repeated measures.ResultsIL 6 and IL 10 release was significantly less (pConclusionsThese results suggest that with the use of heparin-coated circuits there is a lower production of IL 6 and IL 10 from isolated PBMC than with uncoated circuits.Keywords Cardiopulmonary bypass, Cytokine, Heparin coatingReferencesSection:1. Kirklin, J.K., Westaby, S., NBlackstone, E.H., Kirklin, J.W., Chenoweth, D.E., Pacifico, A.D.. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86: 845–57. Google Scholar, Medline, ISI2. Steiberg, J.B., Kapelansky, D.P., Olson, J.D., Weiler, J.M.. Cytokine and complement levels in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993; 106: 1008–16. Google Scholar, Medline, ISI3. Borrelli, E., Giomarelli, P., Naldini, A.. Plasma levels of immunosuppressive mediators during cardiopulmonary bypass. Mediat Inflamm 1996; 5: 51–5. Google Scholar, Medline, ISI4. Hiesmayr, M.J., Spittler, S., Lassnigg, A.. Alterations in the number of circulating leukocytes, phenotype of monocyte and cytokine production in patients undergoing cardiothoracic surgery. Clin Exp Immunol 1999; 115: 315–23. Google Scholar, Medline, ISI5. Nandini, A., Borrelli, E., Cesari, S., Giomarelli, P., Toscano, M.. In vitro cytokine production and T cell proliferation in patients undergoing cardiopulmonary bypass. Cytokine 1995; 7: 165–70. Google Scholar, Medline, ISI6. Nandini, A., Borrelli, E., Carraro, F., Giomarelli, P., Toscano, M.. Interleukin 10 production in patients undergoing cardiopulmonary bypass: evidence for an inhibition of Th1-type responses. Cytokine 1999; 11: 74–9. Google Scholar, Medline, ISI7. Romagnani, S.. The Th1/Th2 paradigm. Immunol Today 1997; 18: 263–6. Google Scholar, Medline8. Wan, S., LeClerc, J.L., Vincent, J.L.. Cytokine response to cardiopulmonary bypass. Lessons learned from cardiac transplantion. Ann Thorac Surg 1997; 63: 269–76. Google Scholar, Medline, ISI9. Butler, J., Rocker, G.M., Westaby, S.. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55: 552–9. Google Scholar, Medline, ISI10. Sablotzki, A., Dehne, M., Welters, I.. Alterations of the cytokine network in patients undergoing cardiopulmonary bypass. Perfusion 1997; 12(6): 393–403. Google Scholar, Link, ISI11. Gu, Y.J., van Oeveren, W., Akkerman, C., Boonstra, P.W., Huyzend, R.J., Wildevuur Ch, R.H.. Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass. Int J Artif Organs 1993; 55: 917–22. Google Scholar12. Wan, S., Izzat, M.B., Yim, A.P.. Reducing inflammatory reactions by heparin-coated circuit. Ann Thor Surg 1998; 66: 1868–73. Google Scholar, Medline, ISI13. Steimberg, B.M., Grossi, E.A., Shwarz, D.S.. Heparin bonding of bypass circuits reduces cytokine release during cardiopulmonary bypass. Ann Thorac Surg 1995; 60: 525–9. Google Scholar, Medline, ISI14. Yamada, H., Kudoh, I., Hirose, Y., Toyoshima, M., Abe, H., Kurahashi, K.. Heparin-coated circiuts reduce the formation of TNF alpha during cardiopulmonary bypass. Acta Anaesthesiol Scand 1996; 40: 311–17. Google Scholar, Medline, ISI15. Deng, M.C

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