摘要
目的观察乌司他丁对二尖瓣置换术患者围体外循环（CPB）期冠状静脉窦血细胞因子水平和心肌细胞间粘附分子-1（ICAM-1）、血管细胞间粘附分子-1（VCAM-1）表达的影响。方法选择20例择期在CPB下行二尖瓣置换术的患者，随机分为对照组（C组）和乌司他丁组（U组），每组10例。分别于转机前（T0）转机30min（T1）、CPB停止即刻（T2）CPB停止后2h（T3）、CPB停止后6h（T4）CPB停止后24h（T5）采集冠状静脉窦血，测定血浆肿瘤坏死因子-α，（TNF-α）、白介素6（IL-6）、白介素8（IL-8）、白介素-10（IL-10）及心肌肌钙蛋白I（cTnⅠ）的浓度变化。同时，于CPB前和CPB结束时取右心房心肌组织标本，检测心肌细胞和血管内皮细胞上ICAM-1、VCAM-1的表达，并进行定量分析。结果在T2-T5时点，U组血浆TNF-α、IL-6、IL-8及cTnⅠ的浓度均低于C组（P〈0．05），IL-10的浓度高于C组（P〈0．05）；U组停机时ICAM-1、VCAM-1的表达低于C组停机时（P〈0．01）。结论乌司他丁通过上调抗炎因子IL-10的分泌和抑制促炎因子TNF-α、IL-6、IL-8等的释放，抑制CPB过程中心肌ICAM-1、VCAM-1的表达，减轻CPB所致的心肌局部炎性反应及心肌损害。
OBJECTIVE To investigate the effect of ulinastatin on myocardial inflammatory response during cardiopulmonary bypass（CPB） in patients undergoing valve replacement. METHODS Twenty ASA Ⅱ -Ⅲ patients scheduled for elective mitral valve replacement undergoing CPB were randomly divided into two groups： control group （C） and ulinastatin group （U）, 10 cases in each group. In group U ulinastatin 20 000U/kg was added to the priming fluid,in group C received normal saline instead of ulinastatin. Blood samples were taken from coronary sinus for determination of plasma TNF-α, IL- 6 ,IL- 8, IL- 10 and cTn I concentrations. The right atrium myocardial samples were obtained to assay the expression of intercellular adhesion molecule - 1 （ ICAM - 1 ） and vascular cell adhesion molecule - 1 （ VCAM - 1 ） on cardiac myocyte and myocardial vascular endothelia cell. RESULTS Compared with group C,the plasma level of TNF-α,IL -6,IL -8 and cTnⅠ in group U decreased significantly while IL -10 increaseed significantly （ P 〈 0.05 or P 〈 0.01 ）. The expression of ICAM - 1 and VCAM - 1 after CPB in group C were higher significantly than that in group U （ P 〈 0.01 ）. CONCLUSION Ulinastatin may accelerate the secretion of IL - 10 and inhibit the secretion of TNF - α, IL - 6 ,IL - 8. which inhibit the expression of ICAM - 1 and VCAM - 1 on cardiac myocyte and myocardial vascular endothelia cell ,so that it relieve the local myocardial inflammatory response and myocardial injury induced by CPB.
出处
《中国体外循环杂志》
2006年第1期18-22,共5页
Chinese Journal of Extracorporeal Circulation
基金
广西卫生厅资助课题(2003106)
关键词
胰蛋白酶抑制剂
体外循环
细胞因子
粘附分子
心肌保护
Trypsin inhibitors
Cardiopulmonary bypass
Cytokines
Adhesion molecule
Myocardial protection
