The Study Of Relationship Between TNF-α, IL-6 And Energy Metabolism In Patients With Valve Replacement Of Rheumatic Heart Disease

Backgrounds: Stress conditions such as sepsis,trauma andoperation are in high metabolism , which result indownregulation of the glucose oxygenization,accompanying withthe upregulation of lipid metabolism and proteindissimilation。It is necessary to access the energy expenditureto nutrition support , but the assessment of the energyexpenditure is very difficult in the clinic practice。 Cardiopulmonary Bypass causes a series of secretion andactivation of cytokines such as TNF-α,IL-1,IL-6 etc, whichcan modulate the disorders of energy metabolism and affect theprognosis .The aim of the study is to observe the changes of TNF-α,IL-6 in patients with CPB and to explore the relationshipbetween TNF-α,IL-6 and REE ,in order to find some effectiveand early biochemical indicators associated with REEspontaneously. Objective: To explore the relationship of the cytokines withthe REE, and to find some effective and early biochemicalindicators, we measure the REE perioperation of CPB in valvereplacement of rheumatic heart disease with indirectcalorimeter and observe the change of REE synchronously, aswell as the levels of TNF-α,IL-6. Methods : Seventeen patients of valve replacement ofrheumatic heart disease taken the Cardiopulmonary bypassoperation ,which ages are between 30～50, are investigated inthe department of cardiothoracic surgery of Nanjing GeneralHospital of Nanjing Command, except for the patients of theemergency and that treated by hormone or non-steroidalanti-inflammatory drugs (NSAID). The levels of REE weremeasured by indirect calorimeter,and plasma concentrations ofTNF-α,IL-6 were measured by ELISA at 8 AM of the day beforethe operation and the 1st,3rd,5th and 7th day after theoperation. Data are presented as means±1 SE and comparisonswere made by analysis of variance (ANOVA) with SPSS11.01. Theregression analysis was utilized to define the correlationsbetween the concentrations of TNF-α,IL-6 and the REE. Results: (1)The plasma concentration of TNF-α were18.12±2.99,27.27±3.78,18.80±3.27,17.60±2.57,17.21±2.22(pg/ml) before operation,the 1st,3rd,5th and 7th day afteroperation sepectively, the levels of the TNF-α in preoperationcorrelate with the first day after operation were significant(P<0.01), but correlate with the 3rd,5th,7th day afteroperation were no significance(P>0.05)。(2)The plasmaconcentration of IL-6 were 14.95±2.88,46.40±7.72,31.49±7.84,20.55±3.95,14.55±2.57 (pg/ml) beforeoperation,the 1st,3rd,5th and 7th day after operationrespectively , the levels of the IL-6 in preoperationcorrelate with the 1st,3rd,5th day after operation weresignificant (P<0.01),but correlate with the 7th day afteroperation were no significance(P>0.05)。(3)The REE were1244.47±186.77,1661.35±251.28,1456.47± 231.31,1355.94±205.79,1252.82±184.95(Kcal/d) before operation,the 1st,3rd,5th and 7th day after operation sepectively, the levelsof the REE in preoperation correlate with the 1st,3rd,5th dayafter operation were significant (P<0.01),but correlate withthe 7th day after operation were no significance(P>0.05)。(4)The correlation between plasma IL-6 and REE was significantduring CPB, but could not find the relationship between TNF-αand REE. Conclusions: The impaction of the cardiopulmonary bypass onenergy metabolism is clear in valve replacement with rheumaticheart disease patients, and IL-6 is one effective indictor inassessment of the resting energy expenditure。...