抑制心内直视术中核转录因子激活保护心肌

Protecting myocardium by inhibiting the activation of nuclear factor kappa B in open heart surgery

目的在人类体外循环(CPB)心内直视手术中研究核转录因子-kB(NF-kB)的激活与心肌白细胞浸润及损伤的关系,并观察氧自由基清除剂辅酶Q10对NF-kB激活的抑制作用及其对心肌的保护作用。方法选取47例接受CPB心内直视手术的成年患者,随机分为对照组30例,治疗组17例。治疗组手术前5 d口服辅酶Q10片剂。在体外循环转机前、心脏缺血45 min和再灌注45 min时取右心房肌组织,做心肌组织病理学、超微结构及NF-kB活性观察。术后观察血流动力学指标、血管活性药物剂量和临床指标。结果在缺血45 min及再灌注45 min后,对照组心肌毛细血管腔内可见嗜中性白细胞聚集并黏附于内皮细胞,超微结构损害,细胞胞核和胞浆内均可见NF-kB阳性表达;而治疗组心肌可见少数嗜中性细胞浸润,超微结构损害轻微,细胞胞核和胞浆内有微弱的NF-kB阳性表达。术后两组血流动力学指标、血管活性药物剂量和临床指标间无显著差异。结论NF-kB在心内直视术中的心肌缺血和再灌注病理过程中起重要作用,辅酶Q10对NF-kB激活有明显抑制作用,并对心肌有保护作用。

Objective To investigate the relationship of the activation of nuclear factor kappa B （NF-kB） with myocardial neutrophil infiltration and injury in human open heart surgery, and to observe the inhibiting effect on the activation of NF-kB and protecting effect on myocardium of the coenzyme Q10, a scavenger of oxygen free radicals. Methods Forty-seven adult patients undergoing open heart surgery were randomly divided into two groups, the control and the treatment. CoenzymeQ10 tablets were given to the treatment group 5 days before operation. Biopsy of right atrium for myocardial pathology, activated NF-kB detection and ultrastructure observation were done prior to cardiopulmonary bypass, 45 minutes of ischemia and 45 minutes of reperfusion. The dynamic indexes, vasomotor drug dosage, and outcomes were observed postoperatively. Results Upon 45 minutes of ischemia and 45 minutes of reperfusion, in control group there were neutrophil accumulation and adhesion of vascular endothelium, ultrastructural damages, and positive expression of NF-kB both in nuclei and cytoplasm, in myocardium. In treatment group, there were only mild neutrophil infiltration and ultrastructural damages, and weak positive expression of NF-kB both in nuclei and cytoplasm. However, the dynamic indexes, vasomotor drug dosage, and outcomes of two groups were not significantly different. Conclusion NF-kB plays an important role in pathophysiological process of myocardial ischemia and reperfusion in open heart surgery. CoenzymeQ10 has obvious inhibiting effect on activation of NF-kB and protecting effect on myocardium.