西维来司钠对体外循环中血浆弹性蛋白酶、补体C_3、C_4及尿NAG的影响

Effects of sivelestat on plasma neutrophil elastase complement C_3,C_4 and urine N-acetyl-beta-D-glucosaminidase during cardiopulmonary bypass on dogs

目的探讨西维来司钠对体外循环(CPB)期间血浆弹性蛋白酶(NE)、补体C3、C4及尿NAG的影响及对肾脏的保护效果。方法将健康成年犬随机分为对照组(C组,N=6)和西维来司钠组(S组,N=6),建立犬CPB模型,两组均在转机前(T1),阻断升主动脉15MIN(T2)、45MIN(T3),开放30MIN(T4)、60MIN(T5)取静脉血和尿液。静脉血离心后测血浆NE和补体C3、C4浓度。尿液测尿NAG。结果①CPB后,两组动物各时点血浆NE含量显著高于CPB前(P<0.01)。同时点组间比较,S组CPB后各时点血浆NE含量均低于C组(P<0.01、P<0.05)。②CPB后C组血浆补体C3含量逐渐下降,CPB末达谷值,明显低于CPB前(P<0.01);组间比较,C组CPB后同时点血浆补体C3含量均低于S组(P<0.01),两组动物血浆补体C4含量无明显差异。③CPB后两组动物尿NAG活性逐渐增加,CPB末达高峰,明显高于CPB前(P<0.01);同时段组间比较,S组尿NAG活性低于C组(P<0.01)。结论CPB中应用西维来司钠可通过抑制NE的活性,减少补体激活及尿NAG活性的增加,对CPB中的肾脏有一定的保护。

Objective To study the effect of sivelestat on plasma neutrophil elastase （NE） and C3 , C4 and urine N-acetyl-beta-D-glucosaminidase （NAG） during cardiopulmonary bypass and its protective effect on renal function. Methods A total of 12 adult hybrid healthy dogs were randomly divided into control group and sivelestat group. The dog model of CPB was established. Levels of plasma NE and C3, C4, and urine NAG were detected before CPB （ T1 ）, 15 min （ T2 ） and 45 rain （ T3 ） after cross-clamping of aorta, and 30 min （ T4 ）, 60 min （T5 ） after aortic unclamping. Results Plasma levels of NE were elevated after CPB in both control group and sivelestat group （P 〈 0.01 ）, but those in sivelestat group were lower significantly than control group after CPB （ P 〈0.01, P 〈 0.05 ）. In control group, the content of C3 after CPB was lower than that before CPB （P 〈0.01 ）, and reached the lowest point at the end of CPB. The content of C3 in control group was lower than sivelestat group at the same time points （P 〈 0.01 ）. The content of C4 showed no obvious diffe-rence in both groups （ P 〉 0.05 ）. The level of urine NAG obviously increased in two groups （ P 〈 0.01 ）, peaked at the end of CPB. Conclusion Sivelestat inhibits the activation of plasma NE and complement C3 and production of urine NAG. Hence, it may exert a protective effect on renal function during cardiopulmonary bypass.