Clinical Study of Anticytokine Therapy during Cardiopulmonary Bypass.
10.4326/jjcvs.28.151
- VernacularTitle:体外循環における抗サイトカイン療法の臨床的検討
- Author:
Norihisa Karube
;
Takayuki Kosuge
;
Ichiya Yamazaki
;
Akira Sakamoto
;
Yasuko Uranaka
;
Yukio Ichikawa
;
Ryuji Adachi
;
Tamitaro Soma
- Publication Type:Journal Article
- Keywords:
SIRS
- From:Japanese Journal of Cardiovascular Surgery
1999;28(3):151-157
- CountryJapan
- Language:Japanese
-
Abstract:
Cardiac operations involving cardiopulmonary bypass can cause a systemic inflammatory response such as elevation of inflammatory cytokines, which can cause organ failure. We investigated cytokine production and its inhibition by ulinastatine in patients undergoing elective coronary artery bypass grafting under cardiopulmonary bypass. Thirty-three patients received either ulinastatine (300, 000 units, intracoronary artery injection immediately after aortic closs-clamping, UTI group, n=16) or no ulinastatine (control group, n=17). Arterial blood samples were obtained at aortic closs-clamping, 5 minutes after aortic declamping, and 6, 12 and 18 hours after surgery and there were assayed for interleukin-6 (IL-6), interleukin-8 (IL-8), and polymorphonuclear leukocyte elastase (PMNE). In addition, we examined liver function (GOT, GPT, and total bilirubin), renal function (blood urea nitrogen and serum creatinine), and oxygenatory function (PaO2/FIO2) postoperatively. IL-8 levels at 5 minutes after aortic declamping and maximum IL-8 levels were significantly lower in the UTI group than in the control group (25.5±12.8 vs. 47.8±38.9pg/dl, p<0.05, and 28.6±13.2 vs. 58.4±40.0pg/dl, p<0.05). Blood urea nitrogen on the second post operative day (POD) and three POD and creatinine on the second POD were also significantly lower in the UTI group than the control group. Furthermore, IL-8 and PMNE levels significantly correlated positively with blood urea nitrogen and creatinine. There was significant negative correlation between IL-8 and oxygenatory function. These results shows that the ulinastatine can inhibit IL-8 levels following cardiac surgery. To combat the increase of inflammatory cytokines such as IL-8 after cardiopulmonary bypass, the ulinastatine should be used for anticytokine therapy to protect the kidneys, lungs, and other organs, and thereby decrease the risk of complications.
