缺血预处理通过抑制炎症反应保护心肌细胞的研究

The protective effects of ischemic preconditioning by decreasing the inflammatory response

目的探讨缺血预处理（IP）对心肌细胞的保护作用及其机制。方法2004年4月至2004年12月期间在我科行瓣膜置换手术的患者36例，根据是否采取缺血预处理分为预处理组（20例）和对照组（16例），比较两组炎症因子白细胞介素（IL）-8、IL-10、肿瘤坏死因子-α（TNF-α）和心肌细胞转录因子NF-κB p65蛋白的变化情况，分析IP对机体炎症反应的影响。结果两组患者细胞因子IL-8、IL-10、TNF-α均在主动脉开放6h时达到高峰，术后5d均恢复到术前水平。预处理组开放后6h、术后1d、术后2d IL-8和TNF-α水平明显低于对照组（P〈0．05），IL-10水平显著高于对照组（P〈0．05）。复灌后两组心肌细胞中NF-κB p65蛋白表达明显增多，预处理组表达量明显低于对照组（P〈0．05），与术后1d TNF-α呈正相关。结论缺血预处理可能通过降低机体的炎症反应途径达到心肌细胞保护的效果。

Objective To explore the mechanism of human myocardial cells protection after ischemia/reperfusiou （I/R） injury by preconditioning with ischemia. Methods Data of thirty-six patients underwent valve replacement were collected. They were divided into the ischemie preconditioning group （ IP group, 20 cases ） and non-ischemic preconditioning group （ contrast group, 16 cases） according to whether they were given single cycle reperfusion before cardioplegia or not. Serum level of interleukin-8,10 and tumor necrosis factor-alpha （TNF-α） were measured with ELISA. Expression of myocardial nuclear facter-κB p65 was analyzed. Results The inflammatory factor IL-8, IL-10 and TNF-αincreased to the highest level in serum on hours 6 after declamping and recovered to normal level on day-5 after declamping. On hour-6, D-1 and D-2 after declamping, serum level of IL-8 and TNF-α were significantly lower in IP group than those in the contrast group （ P 〈 0.05 ）, but serum level of IL-10 was higher in IP group （P 〈 0.05 ）. Expression of myocardial NF-κB p65 increased in both groups after reperfusion, and its level was higher in the contrast group than that in IP group （P 〈 0.05）. Conclusion Ischemic preconditioning have the effect of protection of human myocardial cells after ischemia/reperfusion injury through decreasing systemic inflammatory response following ischemia reperfusion injury.