【摘要】 目的　探讨围术期胃癌根治术细胞因子TNF -α、IL - 6、IL - 10和IL -lra的变化 ,并对 3种麻醉方法进行对比观察。方法　选择 30例胃癌根治术病人 (ASA　I～Ⅱ级 )随机分为 3组 (每组 10例 ) ,即异氟醚和芬太尼麻醉 (IH组 )、全凭静脉异丙酚和芬太尼麻醉 (IV组 )、异氟醚 +硬膜外麻醉 (IE)组。麻醉前、切皮后90min、术后第 4h和 2 4h采集静脉血样。细胞因子TNF -α、IL - 6、IL - 10和IL -lra均采用放射酶联免疫吸附法 (ELISA)测量。结果　胃癌病人麻醉前细胞因子TNF -α、IL - 6、IL - 10均显著高于健康志愿者 (P <0 .0 1) ,而IL -lra无显著改变 (P >0 0 5)。同麻醉前比较 ,切皮后 90min、术后 4h和 2 4h ,IL - 6和IL -lra均显著增高 (P <0 0 1) ,而TNF -α和IL - 10均无显著差异 (P >0 0 5)。与麻醉前比较 ,切皮后 90min ,IH组IL - 6显著增高 (P <0 0 5) ;术后 4h和 2 4h3组IL - 6均显著高于麻醉前 (P <0 .0 5)。 3组围术期TNF -α和IL -10均无显著差异 (P >0 .0 5)。与麻醉前比较 ,切皮后 90min、术后 4h和 2 4h　 3组IL -lra均显著增高 (P <0 .0 1)。组间比较 ,细胞因子均无显著差异 (P >0 .0 5)。结论　胃癌细胞分泌细胞因子TNF -α、IL - 6和IL -10。我们认为 ,围术期细胞因子的变化主要取决?更多还原

【Abstract】 Objective To evaluate the perioperative changes of tumor necrosis-a (TNF-α), interleukine-6 (IL-6), interleukine-10 (IL-10) and interleukine-1 receptor antagonist (IL-1ra) in patients (ASA I-II) with gastric cancer undergoing radical surgery and to compare the effects of three anesthetization on them. Methods 30 patients scheduled to be performed gastric cancer radical surgery were randomly allocated to receive inhalation anesthesia with isoflurane and fentanyl (IH group, n=10), total i.v. anesthesia with propofol and fentanyl (IV group, n=10) and anesthesia with isoflurane and epidural anesthesia. Venous blood samples for measurement of TNF-α, IL-6, IL-10 and IL-1ra were taken before induction of anesthesia and at set intervals until 24h postoperatively. The available enzyme-linked immunosorbent assay (ELISA) kits were used to measure TNF-α, IL-6, IL-10 and IL-1ra. Results Levels of TNF-α, IL-6 and IL-10 were high in patient with gastric cancer before induction in comparison with those of normal controls (P<0.01). TNF-α and IL-10 levels remained low throughout the study. However, all patients showed a significant intra-operative and postoperative increase in IL-6 and IL-1ra (P<0.05). levels of IL-6 was high in three groups at 4h, 24h postoperatively (P<0.05). There was a significant increase of IL-6 in IH group at 90min intra-operatively (P<0.05), but not in IV group. IL-1ra levels increased significantly throughout the study (P<0.01). Levels of TNF-α, IL-6, IL-10 and IL-1ra were not different significantly among three groups (P>0.05). Conclusion IL-6 and IL-1ra in patients (ASA I-II) with gastric cancer undergoing radical surgery increased perioperatively. It suggested that gastric cancer cells might secrete TNF-α, IL-6 and IL-10. The major surgery injury and malignant disease may play a more important role in the perioperative changes of cytokines compared with anesthesia.更多还原