小儿先天性心脏病手术中心肌特异脂肪酸结合蛋白监测

Changes of h-FABP in myocardial ischemic and reperfusion injury during correction of cardiac defects in children

目的:研究小儿先天性心脏病(先心病)手术中心肌缺血再灌注损伤患者体内心肌特异脂肪酸结合蛋白(hFABP)、乳酸脱氢酶(LDH)和磷酸肌酸激酶同工酶MB(CKMB)的特异性变化。方法:将45例先天性心脏畸形矫治术患儿分为3组,每组15例,Ⅰ组为心肌未缺血组,Ⅱ组为心肌缺血时间小于60min组,Ⅲ组为心肌缺血时间大于60min组,分别于切皮前、开放循环后(Ⅰ组为手术结束后)1h,6h,12h,24h,48h,72h,96h取静脉血,检测血清hFABP、LDH和CKMB浓度。应用电镜观察Ⅱ、Ⅲ组患儿主动脉阻断前及开放循环后心肌组织的超微结构。结果:Ⅰ组hFABP活性在手术前、后各时间点变化不明显,在Ⅱ、Ⅲ组开放循环后1h即显著升高(P<0.01),Ⅱ、Ⅲ组组间比较1h、6h、12h差异有统计学意义(P<0.01);Ⅱ、Ⅲ组开放循环后6h血清CKMB浓度明显增加(P<0.01),Ⅱ、Ⅲ组组间比较在48h差异有统计学意义(P<0.01);随缺血时间延长LDH活性增加,但Ⅱ、Ⅲ组间差异无统计学意义(P>0.05)。电镜下观察Ⅱ组、Ⅲ组开放循环后心肌细胞发生损伤性改变,且随缺血缺氧时间延长而加重。结论:hFABP可以作为小儿先心病畸形矫治术中评价缺血再灌注损伤早期敏感而特异的指标,且其血浆浓度的改变与心肌缺血再灌注损伤程度呈正相关,为临床研究术中心肌保护效果提供可靠的依据。

Aim： To investigate changes of heart fatty acid-binding protein（h-FABP） in myocardial ischemic and reperfusion injury during correction of cardiac defects in children. Methods： A total of 45 children accepted correction of cardiac defects were allocated into three groups（ group Ⅰ：no myocardial ischemia, group Ⅱ：myocardial ischemia less than 60 min, and group Ⅲ：myocardial ischemia more than 60 min）. Blood samples were collected before skin incision and at 1 h, 6 h, 12 h,24 h,48 h, 72 h,96 h after operation or reperfusion. The levels of CK-MB, LDH and h-FABP were determined. The changes of myocardial tissue was observed under the electron microscope before ligation and after reperfusion. Results： The level of hFABP was increased significantly at 1 h after reperfusion in the group 11 and group Ⅲ（ P 〈 0.01 ） and there were significant differences between the 2 groups at 1 h, 6 h, and 12 h（P 〈0.01 ）. The level of CK-MB was increased significantly at 6 h after reperfusion in the group Ⅱ and group Ⅲ（P 〈0.01 ）and there was significant difference at 48 h between the 2 groups（P 〈 0.01 ）. The activity of LDH was increased with the time of myocardial ischemia,but there was no significant difference between group Ⅱ and group Ⅲ（P 〉 0.05）. Electron microscopy demonstrated that the myocardial cells were injured after the reperfusion which got more severe with the time of myocardial ischemia. Conclusion： h-FABP could be used as an early and sensitive biomarker of ischemic and reperfusion injury during correction of cardiac defects in children. The concentration of h-FABP is positively correlated with the degree of ischemia, therefore evaluation of the release of h-FABP could be used to assess the myocardial protective effects during the operation.