前列地尔对小儿体外循环术后细胞因子及MMP-9的影响

Effects of alprostadil on plasma levels of proinflammatory cytokines and MMP-9 during cardiopulmonary bypass in children under open heart surgery

目的观察前列地尔对小儿体外循环术后后细胞因子及基质金属蛋白酶-9(MMP-9)的影响。方法先天性心脏病择期手术患儿27例,按随机数字表法分为前列地尔组(P组,15例)和对照组(C组,12例)。C组不给药,P组预充液中加入前列地尔10ng/ml。麻醉诱导后即从中心静脉持续泵入前列地尔10ng(/kg·min)至手术结束。于麻醉诱导后(T1),主动脉开放后30min(T2)、2h(T3)、6h(T4)及24h(T5)酶联免疫吸附(ELISA)法测动脉血浆中IL-6、IL-8、IL-10、TNF-α和MMP-9的水平。结果P组T2点IL-6、TNF-α水平明显低于C组(均P<0.05),T2点及T4点IL-8水平明显低于C组(均P<0.05)。两组各时点IL-10及MMP-9水平比较差异无统计学意义(均P>0.05)。结论前列地尔能有效抑制体外循环中促炎因子TNF-α、IL-8及IL-6的释放,尚不能抑制或增加抗炎因子如IL-10及MMP-9的产生。

Objective To investigate the effect of alprostadil on plasma levels of proinfiammatory cytokines and MMP-9 in pediatric patients undergoing cardiopulmonary bypass （CPB）. Methods Twenty-seven pediatric patients with congenital heart diseases undergoing cardiac surgery were divided into alprostadil group （group P, n =15） and control group （group C, n =12）. Patients in group P received alprostadil 10 ng/ （kg·min） through central venous catheter after induction of anesthesia and 10ng/ml through fluid-filled pump during operation. IL-6, IL-8, IL-10, tumor necrosis factor-cc （TNF-α） and matrix metalloproteinase-9 （MMP-9） levels in arterial blood were measured before CPB （T1） , and 30 min （T2）, 2 h （T3）, 6 h （T4）and 24h （T5） after the declamping of aorta. Results Plasma levels of IL-6 and TNF-α in group P at T2 point were lower than those in group C （ P 〈 0.05）. Plasma concentrations of IL-8 at T2 and T4 in group P was lower than those in group C （ P 〈 0.05）. There were no differences in IL-10 and MMP-9 between two groups. Conclusion Alprostadil may inhibit cardiopulmonary bypass-induced inflammation by suppressing proinflammatory cytokine production, in children undergoing open heart surgery.