Effect of high epidural anesthesia on interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy

Xiuyu LI; Xiaomin XIN; Fengqi LIU

ABSTRACT

BACKGROUND:

Serum cytokines in patients with dilated cardiomyopathy are increased obviously, and the expression of interleukin-6mRNA is also observed in myocardial tissues. High epidural anesthesia can block the vicious cycle involving cytokines and improve cardiac function.

OBJECTIVE:

To observe the changes of interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy after high epidural anesthesia treatment.

DESIGN:

A case-controlled analysis.

PARTICIPANTS:

Thirty-five inpatients with dilated cardiomyopathy were selected from the Department of Cardiology, First Hospital Affiliated to Harbin Medical University, from October 2001 to May 2002. All the patients were randomly divided into high epidural anesthesia group and conventianal treatment group. High epidural anesthesia group consisted of 22patients, 15 males and 7 females, whose cardiac function was classified into grade Ⅱ in 4 patients, grade Ⅲ in 9 and grade Ⅳ in 9. Conventional treatment group consisted of 13 patients, 11 males and 2 females, whose cardiac function was grade Ⅱ in 1 patient, grade Ⅲ in 5 and grade Ⅳ in 7. Healthy control group comprised 21 people, 13 males and 8 females,who received physical examination at the same period.

INTERVENTIONS:

Patients with dilated cardiomyopathy were treated with high epidural anesthesia and conventional method, whereas those in conventional treatment group were treated with conventional method only.Elbow venous blood of 3 Ml was sampled from all patients on empty stomach in the morning before treatment and after 4-week treatment. The level of serum interleukin-6 and soluble interleukin-2 receptor was measured with enzyme-linked immunoadsorbent assay. MAIN OUTCOME

MEASURES:

The level of serum interleukin-6 and soluble interleukin-2 receptor of patients in eachgroup.

RESULTS:

Blood samples of the 56 subjects were qualified and entered the final analysis.①The level of serum interleukin-6 was higher in dilated car diomyopathy group (13.9ng/L) than in healthy control group (11.22 ng/L) (z= -3.072, P ＜ 0.05). ② The level of serum interleukin-6 in high epidural anesthesia group was obviously decreased aftertreatment (11.42 ng/L) as compared with that before treatment (20.42ng/L) (z =2.582 9, P ＜ 0.05).The le vel of serum interleukin-6 in conventional treatment group was similar before and after treatmant(12.16 ng/L and 12.80 mg/L, z = -1.89,P ＞ 0.05). The difference of interleukin-6 level in high epidural anesthesiagroup (-2.04 ng/L)was obviously higher than that in conventional treat ment group (0.28 ng/L) (P ＜ 0.01) before and after treatment.③The level of serum soluble interleukin-2 receptor was higher in dilated car diomyopathy group[(1 306.17±1.46)ng/L]than in healthy control group [(1078.95±1.23) ng/L] (t =2.51, P ＜ 0.05). ④ The level of soluble intedeukin-2 receptor in high epidural anesthesia group was decreased after treatment [(1 086.68±1.34)ng/L]as compared with thatbeforetreatment [(1 328.01±1.51) ng/L], (t =2.145, P ＜ 0.05). The level of soluble interleukin-2 receptor in conventional treatment group was similar before and after treatment [(1 473.33±1.66) ng/L and (1 331.07±1.52) ng/L,t=-1.06, P ＞ 0.05].

CONCLUSION:

The level of serum interleukin-6 and soluble inter leukin-2 receptor is significantly decreased after high epidural anesthesia, suggesting that high epidural anesthesia can regulate cytokines better than conventional treatment.The regulation of high epidural anesthesia is related to inhibition of sympathetic nervous system and humoral-im mune system.