摘要
目的：检测心脏外科手术对于外周血中心肌营养素-1（CT-1）表达的影响和围术期心肌中CT-1的表达变化,并探讨其在心脏外科的临床应用价值。方法：①50例非体外循环冠状动脉旁路移植术（OPCABG）患者,于术前、术后6小时、术后3天、术后1周取外周静脉血测定CT-1浓度,术后10个月随访再次检测,并记录心功能临床指标进行比较。②15例体外循环心脏手术患者,于术前、术后6小时、术后3天、术后1周监测外周血CT-1浓度;并分别于体外循环开始和结束时,取右心耳心肌组织活检,免疫组化测定CT-1蛋白表达水平。结果：①50例OPCABG患者随访率63.3%。外周血CT-1水平在围术期没有明显变化,10个月后复查值高于其术前基础值。术前外周血CT-1水平与纽约心脏病协会心功能（NYHA）分级呈正相关,与左心室舒张末期直径呈正相关;与左心室射血分数呈负相关。术后10个月复查结果CT-1水平与NYHA分级、左心室舒张末期直径、左心室射血分数等无明显相关性。②15例体外循环心脏手术心肌缺血时间（49±10）min,围术期外周血CT-1浓度无明显变化,手术主动脉阻断时间（即心肌缺血时间）48（43~54）min。心肌中CT-1蛋白水平缺血后[28.90（26.39~31.08）%]较缺血前[24.25（20.08~29.25）%]升高（P=0.006）,差异有统计学意义。结论：缺血刺激心肌分泌CT-1的增加。心脏外科手术可导致外周血CT-1长期表达的升高。术前外周血CT-1水平可一定程度反映心功能状况。
Objective： To investigate the changes and the meaning of peripheral cardiotrophin-1（CT-1） in patients with cardiac surgery,and to compare the myocardial tissue CT-1 protein expression before and after the ischemia reperfusion injury in surgical procedures.Methods： Our work included two groups of patients.Group①,50 patients with off-pump coronary artery bypass grafting（OPCABG）,their peripheral CT-1 was measured with ELIZA before the operation,and 6 hours,72 hours,1 week and 10 months after the operation.The patients＇ cardiac function was also recorded and compared.Group②,15 patients with extracorporeal circulation cardiac surgery,the patients＇ peripheral CT-1 was examined the same as in Group①.In addition,a piece of right auricle tissue was taken before and after the extracorporeal circulation respectively and the protein level of CT-1 was detected by immunohistochemistry.Results： In Group①,63.3% of patients were followed-up for the average of 43 weeks.Peripheral CT-1 had no significant changes at perioperative period of time,while it was obviously higher than the baseline 10 months after OPCABG.CT-1 was positively correlated with NYHA rank and left ventricular end-diastolic dimension（LVEDD）,but was negatively correlated with left ventricular ejection fraction（LVEF） before the operation.No correlation was found 10 months after OPCABG in CT-1 with NYHA rank,LVEED or LVEF.In Group②,the expression of CT-1 protein in myocardial tissue increased after the cardiac ischemia（P=0.006）.However the peripheral CT-1 level had no obvious changes during the peri-operative period of time.Conclusion： Peripheral CT-1 might be able to reflect the heart function at certain point before the cardiac surgery,cardiac ischemia could increase the level of peripheral CT-1.
出处
《中国循环杂志》
CSCD
北大核心
2010年第6期468-471,共4页
Chinese Circulation Journal
基金
天津市科委自然科学基金课题(基金编号:06YFJMJC08700)
关键词
心肌营养素-1
体外循环
冠状动脉旁路移植术
Cardiotrophin-1
Extracorporeal circulation
Coronary artery bypass grafting
