| Background: Coronary artery bypass grafting is a classic surgery to therapy coronary artery disease now. Myocardial ischemia-reperfusion injury associated with cardiac surgery is an acute inflammatory process in which activated leukocytes and endothelial cells play a critical role. Recent investigations have clearly shown that cytokines, a group of low-molecular weight polypeptides which function as intercellular communication molecules, play a central role in inflammatory reactions and particularly in inducing myocardial injury. The steady-unblance between anti-inflammatory and pro- inflammatory is the main reason of myocardial damage and multi-organ handicapped. Inflammatory reaction is a complic process, it refer to many kinds of inflammation mediators. The most studied pro-inflammatory cytokines include tumor necrosis factor (TNF-α), interleukin (IL)-6, and IL-8. Meanwhile, the important anti-inflammatory capacity of IL-10 has also been widely known. To study and research the level of inflammatory factor after CABG can guide us to prevent organ functional disturbance after surgery.Objectives: 1. to observe the changes of IL-6, IL-8, IL-10 and TNF-αbefore and after on-pump coronary artery bypass grafting(CABG) and off-pump coronary artery bypass grafting(OPCABG), and discuss the correlations between the expression of inflammatory factor and myocardial damage. 2. to discuss the clinical significance of the balance between pro-nflammatory and anti-inflammatory cytokines and the clinical use of liquichip.Methods: Blood samples were obtained from 158 patients before, and 1, 4, 24, 72h after coronary artery bypass grafting. IL-6, IL-8, IL-10, TNF-αwere measured by liquichip. Biochemistry index as CKMB, TNI, Bun were detected at equal pace. Volume of blood loss, blood pressure and other clinical data were recorded throughout the perioperative period.Results: The levels of IL-6, IL-8, IL-10 and TNFa showed dynamic change in CABG during perioperation. In comparison with the preoperative values, plasma levels of IL-6, IL-8, and IL-10 increased significantly after CABG and this lasted during the study period. Concentrations of IL-6, IL-8 and IL-10 reached the peak value at 1 h after CABG and started to decline afterward. The levels of IL-6, IL-8 and IL-10 didn't returned to preoperative levels at 72 hour (p<0. 05). TNF-a showed a slightly decreased at 1 hour and reach the bottom at 24 hour after surgery, it returned to preoperative levels at 72 hours (p>0.05) . There was no significant difference between two groups preoperatively. In the CPB group, the increase of IL-6, IL-8, and IL-10 were greater than that in the off- pump group at 1 hour and at 4 hour. For IL-6, a strong increased was observed at 1hour , 4hour and 24hour after surgery(p=0.049, p=0.034, p=0.007); a similar response was observed for IL-8 and IL-10, with increased values for group 2 starting at 1 hours after surgery and a continuous elevation for the whole postoperative period. Compared with group 1, groups 2 showed a statistically significant elevation at 1 and 4 hours after surgery (p=0.049, p=0.040; p=0.046, p=0.049). There was only one statistically significant difference for TNF-a when comparing group 1 with group 2; this difference was for the 4-hour postoperative sample (p=0.003). The value of CKMB and TNI after surgery in group 2 was significantly higher than that values in group 1 (P<0.05),IL-6,IL-8,IL-10 is associated in each point (r>0.500) in both group 1 and group 2.Conclusion: 1. CABG is associated with an acute inflammatory process which may persistence throughout the perioperative period. 2. The pro-and anti-inflammatory cytokines were increased after surgery. 3. Intensity of the inflammatory response with CPB showed more stronger than that with off-pump CABG. 4. It indicated slight myocardial injury in off- pump CABG after surgery. |
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