粘附分子的表达在研究心肌缺血再灌注损伤中的作用

Mechanism of Cell Adhesion Molecules on the Myocardial Ischemia-reperfusion Injury During Cardiopulmonary Bypass

目的通过观察体外循环细胞因子及粘附分子的变化,探讨粘附分子sICAM-1及sP-Selectin的表达在体外循环围术期心肌缺血再灌注损伤中的作用及意义。方法择期在体外循环下行心内直视手术患者11例,分别于诱导后切皮前(T1)、转流20min(T2)、停机1h(T3)、停机6h(T4)及停机24h(T5)抽取动脉血,测定肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),血浆可溶性细胞间粘附分子-1(sICAM-1),可溶性P选择素(sP-Selectin)的浓度及肌钙蛋白I(cTnI)的浓度。结果TNF-α、IL-6:与T1相比,在T2、T3、T4、T5均明显升高(P<0.05),sICAM-1、sP-Se lectin:在T3、T4、T5均较T1明显升高(P<0.05),cTnI:在T3、T4、T5均较T1明显升高(P<0.05)。结论体外循环可引起细胞因子及粘附分子的表达上调,有可能加重围术期心肌缺血再灌注损伤。

Objective To explore the role played by Cell Adhesion Molecules on the myocardial ischemia reperfusion injury during cardiopulmonary bypass （CPB）. Methods Eleven ASA Ⅱ - Ⅲ patients, age ranged 20 to 60 years old. Patients with liver/ kidney diseases, received glucocorticoid before operation were excluded. Anesthesia was induced with midazolam 0. 1mg·kg^-1 , fentanyl 10ug·kg^-1 , vecuronium 0. 1mg·kg^-1. After intracheal intubation anesthesia was maintained with midazolam and fentanyl. The patients were mechanically ventilated. Blood samples were taken from radial artery before operation（T1 ） ,20min after initiation of CPB（T2 ）, lh （T3） ,6h（T4 ）, 24h（T5 ） after CPB for determination of plasma TNF-α, IL - 6, sICAM- 1, sP Selectin, cTnl levels. Results Levels of cTnl, sICAM - 1, sP - Selectin increased significantly at T~ - T5, and TNF -α, IL - 6 increased significantly at T2 - T5 as compared with Tj. Conclusions The plasma levels of TNF-α,IL -6, sICAM- 1, and sP- Selectin were significantly increased during CPB, which will result in aggravation of the myocardial ischemia- reperfusion injury.