川芎嗪预处理对心脏手术患者心肌组织热休克蛋白72基因表达的影响

Effect of tetramethylpyrazine preconditioning on the expression of heat shock protein 72 in myocardium during cardiosurgery

目的。研究川芎嗪预处理对体外循环主动脉阻断（ACC）前后非发绀型先天性心脏病矫治术患者心肌组织热休克蛋白72基因表达的影响，并探讨川芎嗪预处理的心肌保护机制。方法28例非发绀型先天性心脏病患者，随机分为对照组和川芎嗪组，每组14例。川芎嗪组预处理麻醉诱导后经颈内静脉滴入川芎嗪3mg／kg，30min内滴完，转流中追加1mg／kg于氧合器中，对照组于上述时间给予等量生理盐水。两组分别于转流前、主动脉开放后30min和术后24h测定外周血心肌酶的变化。结果川芎嗪组心肌组织热休克蛋白72基因的表达量在ACC后明显高于对照组（P〈0．05）。川芎嗪组心肌损伤指标明显低于对照组，差异有统计学意义（P〈0．05）。结论川芎嗪预处理可上调心肌组织热休克蛋白72基因表达，产生一定程度的心肌保护作用，表现为心肌酶漏出减少。

Objective To evaluate heat shock protein 72 （HSP 72） expression in myocardium of non-cyanotic patients of congenital heart disease （CHD） during eardiopulmonary bypass （CPB） surgery for correction of CHD, to investigate if tetramethylpyrazine （TMP） preconditioning can modify the expression of HSP72 mRNA during CPB, and if TMP preconditioning can attenuate CPB-inducod myocardial ischemia-reperfusion injury through a self-protective mechanism. Methods Twenty eight non-cyanotic CHD patients were randomly divided into the control group （n=14） and the TMP group （n=14）.TMP was given to the TMP group by intravenous dripping 3 mg/kg after anesthesia induction and adding 1 mg/kg in oxygenator during CPB. The expressions of HSP 72 were measured in the cardiac tissue from right atrium of the patients before and after aortic cross-clamping （ACC） by semi-quantitative reverse transeription polymerase chain reaction （RT-PCR）. Peripheral levels of AST, LDH, CK, CK-MB were measured before the CPB and 30 minutes after opening aorta and 24 hours after cardiosurgery as markers of heart damage. Resuits The expressions of HSP 72 increased after ACC in the two groups （P〈0.05 ）, the expressions of HSP 72 in the TMP group were higher than that in control group （P〈0.05 ）. The levels of the markers of cardiac injury AST, LDH, CK, CK-MB increased during CPB in the two groups, the concentations of all the markers of cardiac injury in the TMP group were lower than those of the control group （P 〈0.05）. Conclusion These results suggest that HSP 72 expression increased in myocardium of CHD during CPB, and TMP preconditioning could induce HSP 72 expression after ACC and attenuate CPB-induced myocardial ischemia-reperfusion injury through a self-protective mechanism.