乌司他丁对心肺转流心内直视术中细胞因子平衡和心肌细胞凋亡的影响

Effects of ulinastatin on cytokines balance and myocardiocyte apoptosis during cardiac surgery under cardiopulmonary bypass

目的 探讨乌司他丁对心肺转流（CPB）心内直视术患者细胞因子平衡和心肌细胞凋亡的影响。方法 20例择期行二尖瓣置换术患者，随机均分为乌司他丁组（U组）和对照组（C组）。U组给予乌司他丁100万U，其中1万U于转机前静注作过敏试验，99万U加入预充液中；C组用生理盐水代替。于转机前（T0）、转机30min（T1）、CPB停止即刻（T2）、CPB停止后2h（T3）、6h（T4）和24h（T5）采集动脉血，测定血浆肿瘤坏死因子α（TNF—α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）和白细胞介素-10（IL-10）浓度。采用TUNEL法测定两组CPB前和CPB停止后30min右心房的心肌凋亡细胞。结果 U组T2～T5时的IL-6、IL-8和TNF—α浓度明显低于C组（P〈0．01），而IL-10浓度明显高于C组（P〈0．01）。CPB停止后30min，U组心肌细胞的凋亡指数明显低于C组（P〈0．05）。结论 乌司他丁抑制CPB期间TNF-α、IL-6和IL-8的释放，促进IL-10的释放，有利于细胞因子反应平衡的调节；乌司他丁通过抑制细胞凋亡，减少心肌细胞的死亡，可有效的保护心肌。

Objective To investigate the effect of ulinastatin on cytokines balance and myocardial cell apoptosis during cardiopulmonary bypass （CPB）. Methods Twenty patients undergoing elective mitral valve replacement under CPB were randomly divided into two groups with 10 cases each： Group U received ulinastatin 1 000 000 U and group C received normal saline instead of ulinastain. Blood samples were taken from artery before CPB （T0）, at 30 min （T1） during CPB, the end of CPB （T2）, 2 h （T3）,6 h （T4） and 24 h （T5） after the completion of CPB for determination of plasma TNF-α, IL-6, IL-8 and IL-10 concentration. Myocardial tissues were taken from the right atrial before and 30 min after CPB for the apoptotic myocyte count. Results The plasmaconcentrations of TNF-α, IL-6, IL-8 were significantly lower while the IL-10 concentration was significantly higher in group U than those in group C at T2-T5 （P〈0. 01）. At 30 min after CPB,the number of TUNEL positive myoeyte nuclei was significantly lower in group U than that in group C （P〈0.05）. Conclusion Ulinastatin can effectively regulate cytokines balance and down-regulate inflammatory response and inhibit cardiomyocyte apoptosis during CPB.