抑肽酶对瓣膜置换术患者心肌粘附分子表达及细胞凋亡的影响

Effects of aprotinin on the expression of cell adhesion molecules in myocardium and cardiomyocyte apoptosis in patients undergoing cardiac valve replacement

目的探讨抑肽酶对二尖瓣置换术患者围体外循环（CPB）期心肌细胞及心肌血管内皮细胞上细胞间粘附分子-1（ICAM-1）、血管细胞粘附分子-1（VCAM-1）表达及心肌细胞凋亡的影响。方法择期二尖瓣置换术患者30例,年龄24～59岁,体重46～73 kg,心功能分级Ⅱ级或Ⅲ级,随机分为2组（n=15）：对照组和抑肽酶组,抑肽酶组于CPB转机前,预充液中加入抑肽酶300万KIU,对照组则给予等容量生理盐水,分别于CPB前和CPB停止时取右心房心肌组织标本,采用免疫组织化学SP法染色,检测心肌细胞和心肌血管内皮细胞上ICAM-1、VCAM-1的表达,采用病理图像分析系统对ICAM-1、VCAM-1表达的灰度值作定量分析,采用TUNEL法检测凋亡心肌细胞。结果抑肽酶组CPB停止时ICAM-1、VCAM-1的表达低于对照组（P〈0.01）;2组CPB停止时心肌细胞凋亡指数较CPB前增高（P〈0.05）,抑肽酶组CPB停止时心肌细胞凋亡指数低于对照组（P〈0.05）。结论预充液中加入抑肽酶300万KIU可抑制二尖瓣置换术患者CPB期间心肌细胞和心肌血管内皮细胞ICAM-1、VCAM-1的表达及心肌细胞的凋亡。

Objective To investigate the effect of apretinin on cardiomyocyte apoptosis and the expression of intercellular adhesion molecule-1（ICAM-1）and vascular cell adhesion molecule-1（VCAM-1）on myocardial vascular endothelia cell and cardiomyocyte in patients undergoing cardiac valve replacement with cardiopulmonary bypass（CPB）.Methods Thirty NYHA classⅡorⅢpatients aged 24-59 ys weighing 46-73 kg scheduled for cardiac valve replacement under CPB were randomly divided into two groups（n=15 each）：control group and aprotinin group.In aprotinin group aprotinin 30×10^5 KIU was added to the priming fluid while in group C normal saline was added to.Myocardial sample was taken from right atrium before and at the end of CPB for determination of apoptosis in cardiomyocytes by TUNEL and the expression of ICAM-1 and VCAM-1 on myocardial vascular endothelia cell and cardiomyocyte by immuno-histochemistry.Apoptotic index was calculated.Results At the end of CPB,the apoptotic index in cardiomyocyte and the expression of ICAM-1 and VCAM-1 on myocardial vascular endothelia cell and cardiomyocyte were significantly in aprotinin group lower than in control group（P〈0.05 or 0.01）.Conclusion Aprotinin 30×10^5 KIU in priming solution may inhibit the expression of ICAM-1 and VCAM-1 on myocardial vascular endothelia cell and cardiomyocyte,and decrease myocardiocyte apoptosis in patients undergoing cardiac valve replacement with CPB.