HQI NGH! KHOA HQC C O A HOI HOA SINH Y DlfOC H A NOI VA CAC TJNH PHfA BAC LAN THifXVII TAI LIEU T H A M K H A O .
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NGHIEN CCrU Sir BIEN DOI NONG DO IL-6, CRP TRONG HUYET THANH BENH NHAN PHAU THUAT DONG MACH VANH
• • • •
TAI BENH VIEN TRUNG l/ONG HUE
• • •
LS Thi Phu-OTig Anh, Bui Du-c Phii, Hoang Thi Thu Uvvng, Tran Hihi An (*)
TOM TAT
Interleukin-6 (IL-6) va CRP ddng vai trd then chot trong dap lihg viem toan than va ^ n hai to chiit sau tuan hoan ngoai cx^ the, chiing cd le la hull Ich de dy bao trydc nhuhg hau qua xau cua sy giai phdng cytokin gay viem sau tuan hoan ngoai cd the, Tuy nhien, nhieu ghi nhan cho rang nhuYig
miic IL-6, CRP sau phau thuat tim thydng tang cao va cd sy thay doi kha Idn glij^ cac benh nhan, Mac du cd mgt vai tac gia cho rang co sy tydng quan giuci sy gia tang nong do IL-6, CRP vdi thdi gian tuan hoan ngoai cd the hoac vdi thdi gian kep dgng mach chii (hoac ca hai), va tydng quan vdi cac bien chCrtig sau phau thuat cau noi mach vanh, thi
(*) Benh vien Trung uong Hue 104
YHQC VI§T NAM THANG 8 - SO 2/2011 cac tac ga khac cd y kien nguWc lai, va cd che giai
thich dn\ia du'dc hieu ro day dii, VI vay chiing tdi khao sat sy bien doi nong do IL-6, CRP huyet thanh benh nhan phlu thuat cau noi chii vanh, tim sy tu'dng quan giiJa chiing vdi qua trinh phau thuat va cac bien chyng sau phau thuat.
SUMMARY
THE CHANGE OF SERUM IL-6, CRP CONCENTRA-nONS IN THE PATIENTS UNDERGOING CABG AT HUE CENTER HOSPITAL
BACKGROUND
Interleukin-6 (IL-6) and CRP play pivotal roles in systemic inflammation response syndrome and tissue damage after cardiopulmonary bypass (CPB), they may be useful for predicting adverse consequences of proinflammatory cytokine release after CPB, However, reported serum IL-6 and CRP levels associated with cardiac surgery have varied greatly, and wide interinvidual variations in cytokine levels have been observed, Althought some researchers report the increase of IL-6, CRP and the duration of CPB or cross-clamp time (or both), and the complications after CABG to be correlated, data are conflicting and mechanisms responsible for this wide range are not fully understood. So, we investigate the change of IL- 6, CRP concentrations in CABG cases and their correlations with the duration and complications ofCABG,
PAHENTS AND METHOD
Bebween January 2009 and August 2010, this randomized study enrolled 40 patients who undergoing CABG under CPB at Cardiovascular Center of Hue Center Hospital, longitudinal research in the short time.
Exclusive criteria were acute or chronic Infections, the death of perioperation or plus 72h postoperation, emergency surgery, preoperative
renal or hepatic failure, preceding corticoide treatment.
Blood samples were taken to measure the serum concentrations of IL-6, CRP at the induction of anesthesia (Tl), at the start of aortic cross-clamp (T2), at the removal of aortic cross- clamp (T3), at the end of surgery (T4), and 24h (T5), 72h (T6) after the termination of surgery.
Serum IL-6 were assayed by CUA (Chemical Luminescent Immunometric Assay) on Immulite 1000 with assay range was 2 to 1000 pg/ml, Serum CRP were measured using a turbidimetric method on Olympus AU 640 with assay range was 0,2 to 480mg/l,
RESULTS
Male patients were 90% (36), the median age was 58,57 ± 11 ys (range from 31 to 77 year- old), Patients's history were chronic hypert:ension 62,6%; diabete melitus: 20%; dyslipidemia:
72,5%; 5% pts had been PQ before operation.
Before operation, instable and stable angina was 90% and NYHA II 8i III was 90%, renal dysfunction: 12,5%, Coronary artery lesions were as follow: one vessel: 2,5%, hwo- vessels: 42,5%, three vessels: 52,5% and four vessels: 2,5%.
Stenosed degree of 3 and 4 is popular. The duration of surgery: 284 ± 71 min, cross-clamp time: 63+ 20 min, CPB: 111± 44 min, the mean number of graft per patients: 2,4, Total mortality rate was 5% (2pts) caused by MOFS, The main post-operative complications were ARD: llpts; AF:
8pts; bleeding: Spts; MOFS: 2pts; AMI: 1 pts; At least one complication: 16pts. The mean time of stay in ICU: 6,95 ± 8,29 days. The mean time of hospital stay were 16,75 ± 9,66 days.
Serum IL-6 increased immediately at T2 (1799,43 ± 3056,70 pg/ml), T3 (7383,44 ± 9720,70 pg/ml) and reached peak at T4 (14878,75 ± 14413,24 pg/ml), decreased quickly at T5 (999,43 ± 852,06 pg/ml) and remained increased at T6 (99,14 ± 69,17 pg/ml), p < 0,05,
105
HQI NGH! KHOA HQC COA HQI HOA SINH Y DUOC HA NQI VA CAC TJNH PHJA BAC LAN THifXVII Serum CRP increased atT5 (115,06 ± 72,88
mg/l) and reached peak at T6 (143,78 ± 80,90 mg/l), much later than IL-6, p <0,05.
The association between IL-6 Cr4) with duration of surgery (r = 0,38; p= 0,020, cross- clamp time (r = 0,45; p= 0,003), CPB (r = 0,36;
p= 0,023),
There were strong correlations between IL-6 (T4) with renal failure (R = 0,35; p= 0,033), atrial flbrillation (R = 0,40; p= 0,013); SIRS- MOFS (R = 0,60; p= 0,001), and at least one complication (R = 0,55; p= 0,001), There was weak correlation between IL-6 with cognitive disoder (R=0,34; p= 0,037).
There were not any correlations between CRP level (T6) with parameters of surgical procedure and its complications,
CONCLUSIONS
There was a magnitude of increases in serum concentrations of IL-6 and CRP after CABG under CPB, The concentration of CRP after surgery has been reported in peak much later than IL-6.
IL-6 may be useful for predicting adverse consequences of proinflammatory cytokine release after CPB, better than CRP,
I. BENH NHAN VA PHl/ONG PHAP NGHIEN CUU
Bgnh nhan bi benh dgng mach vanh cd
Mlu mau dugrc iky dk dinh lugmg IL-6, CRP d cac thdi diem: BSt dau gay me (Tl), bit d&u kep dgng mach chu (T2), bat dSu nha kep dgng mach chu (T3), kSt thuc phau thuat (T4), sau phau thuat 24 gia (T5), sau phau thuat 72 gid (T6). IL-6 dugrc dinh lugmg yen may Immulite 1000, theo phuomg phap Hda phat quang, vdi gidi ban do ty 2 dkn 1000 pg/mL va CRP dugc do tren may Olympus AU 640 theo phuomg phap do do dye, vdi gidi ban do tu 0,2 dkn 480mg/L.
I I . KET QUA
L Tudi va gidi: Nam chilm 90% (36 bn), hi6i tnmg bmh 58,57± 11 (ty 31 d&i 77 tudi).
2. Tien sii- benh tat: tang buydt ap man 62,6%, dai thao dudmg 20%, rdi loan lipid mau 72,5%. Cd 5% benh nhan da can thiep mach vanh trudc do. Trudc phau thuat, can dau that nguc 6n dinh va khdng 6n dinh 90%
va NYHA II & III 90%, rdi loan chiic nang than 12,5%. T6n thuomg dgng mach vanh: mgt nhanh 2,5%; 2 nhanh: 42,5%; 3 nhanh: 52,5%;
4 nhanh: 2,5%. Chit hep do 3 va 4 la thuong g^.
3. Thoi gian can thiep:
Thdi gian phlu thuat trung binh: 284 ± 71 phut
Thdi gian kep dgng mach chu trung binh: 63 ± 20 phiit
Thdi gian tuIn hoan ngoai ca thi trung chi dinh phlu thuat clu ndi mach vanh tai binh 111 ± 4 4 phut, s6 clu ndi trung bmh la Trung Tam Tim M?ch BVTW Hud, tir thang 2,4 clu.
1 nam 2009 den thang 8 nam 2010, gom 40 bgnh nhan. Sir dung phuang p h ^ nghien ciiu dgc.
Chiing toi loai khdi nhdm nghien curu nhung benh nhan sau:
Nhilm triing d p hoac man truac phlu thuat, chit trong phlu thuat hoac 72 gid sau
- Ty Ig tu vong la 5% (2 bn) do suy da tang. Cac biln chiing chinh sau phlu thuat: Suy than cap: 11 benh nhan; Rung nhi: 8 benh nhan; Chay mau qua miic: 3 benh nhan; Suy da tang: 2 benh nhan; Nhdi mau ca tun: 1 benh nhan; Cd it nhIt I biln chiing: 16 benh nhan phau thuat, phau thuat cap ciiu do hgi chiing (40%). Thdi gian nam hoi sue tang cudng vanh d p , suy than, suy gan, dilu tri trung binh: 6,95 ± 8,29 ngay; thoi gian n3m Corticoid truac phlu thu^t, da PTCNMV vign hung binh: 16,75 ± 9,66 ngay.
trudc do.
106
Y HQC VIET NAM T H A N G 8 - SO 2/2011
Bang L Nong dg Interleukin-6, CRP theo tung thdi diem nhdm nghien ciiu
Thdi diem Tl T2 T3 T4 T5 T6 P
IL-^(pg/mL) X ± S D 4,27 ± 2,03 1799,43 ± 3056,70 7383,44 ± 9720,70 14878,75 + 14413,24
999,43 ± 852,06 99,14 ± 69,17
<0,05
CRP.(mg/L) Xd:SD 4,18 ±3,75 3,81 ± 3,75 4,36 ± 5,00 8,23 ± 8,17 115,06 + 72,88 143,78 ± 80,90
<0,05
