乌司他丁对胆道探查加胆囊切除术患者中性粒细胞CD11b/CD18表达的影响

EFFECT OF ULINASTATIN ON EXPRESSION OF CD11b/CD18 BY NEUTROPHILS IN COMMON BILE DUCT EXPLORATION AND CYSTECTOMY

目的观察乌司他丁对胆道探查加胆囊切除术患者中性粒细胞(polymorphonuclear neutrophil,PMN)CD11b/CD18表达水平的影响。方法 20例胆道探查加胆囊切除术患者,美国麻醉医师协会(American society ofanesthesiologis,ASA)体格健康状况分级Ⅰ～Ⅱ级,随机平分为2组(乌司他丁组和对照组)。乌司他丁组,于麻醉诱导后、手术开始前将乌司他丁20万U加入120 mL生理盐水,以2 mL/min速度持续静脉滴注。对照组,以等量生理盐水代替。分别于麻醉诱导后即刻、手术开始后4、12、24 h抽取外周静脉血,用流式细胞仪检测PMN表面CD11b/CD18分子表达水平。结果乌司他丁组与对照组麻醉诱导后即刻PMN表面CD11b/CD18分子表达水平差异无统计学意义(P>0.05)。乌司他丁组各时间点PMN表面CD11b/CD18分子表达水平差异无统计学意义(P>0.05)。在对照组中,PMN表面CD11b/CD18分子表达水平于手术开始后4、12、24 h与麻醉诱导后即刻相比差异有统计学意义(P<0.05),手术开始后24 h与手术开始后4 h相比差异仍有统计学意义,24 h时升高最为明显(P<0.05)。结论胆道探查加胆囊切除术可导致循环中PMN表面CD11b/CD18分子表达水平明显升高,乌司他丁能抑制PMN表面CD11b/CD18分子表达的增加,从而抑制PMN的过度激活,保护机体的组织和重要器官的功能。

Objective To examine the expression of CD11b/CD18 by polymorphonuclear neutrophils(PMN)and the effect of ulinastatin on the PMN CD11b/CD18 expression during common bile duct exploration and cystectomy,and to investigate role of ulinastatin on the modulation of inflammation and on the protection of organ function.Methods Twenty ASA Ⅰ～ Ⅱ patients scheduled for common bile duct exploration and cystectomy under general anesthesia were randomly divided into two groups,ulinastatin group and control group.Ulinastatin group received intravenous infusion of ulinastatin 2×10~5 IU in 120 mL normal saline before skin incision at the rate of 2 mL/min,control group received same amount of normal saline instead of ulinastatin.Blood samples were taken at the following time point,immediately following anesthetic induction,at 4,12 and 24 h following skin incision.Flow cytometry was used to measure the expression of CD11b/CD18 by PMN.Results There was no significant difference of CD11b/CD18 expression by PMN between ulinastatin and control group immediately following anesthetic induction(P>0.05).There was no significant alteration of CD11b/CD18 expression by PMN in ulinastatin group among the three time point(P>0.05).While,the level of CD11b/ CD18 in control group increased significantly at 4,12 and 24 h following surgical intervention when compared to that immediately after anesthetic induction(P<0.05).Conclusion Common bile duct exploration and cystectomy can increase the expression of CD11b/CD18 by PMN,and ulinastatin can decrease the expression of CD11b/CD18 by PMN and may protect the organ function.