乌司他丁对心脏瓣膜置换术患者炎性因子的影响

Effects of Ulinastatin on Inflammatory Response to Cardiopulmonary Bypass in Cardiac Valve Replacement Surgery

目的研究乌司他丁在体外循环（cardiopulmonreal bypass，CPB）心脏瓣膜置换手术中对炎性细胞因子以及炎症反应的影响。方法选择择期体外循环下行瓣膜置换术病人36例，随机分为乌司他丁组（U组）和对照组（C组），每组18例。U组给予乌司他丁1．2×10^4U／kg，C组予与等容量生理盐水。分别于麻醉诱导前（T1），CPB开始后1h（T2），CPB停止后1h（T3），CPB停止后24h（T4）抽取动脉血，用酶联免疫吸附（ELISA）法测定血浆肿瘤坏死因子α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-10（IL-10）浓度。结果两组病人血浆TNF-α、IL-6和IL-10的浓度，在T2～T4各时点与CPB前比较均明显增加（P〈0．05）；T2-T4时点U组血浆TNF—α和IL-6浓度明显低于C组（P〈0．01），IL-10浓度明显高于C组（P〈0．05）。结论乌司他丁能抑制CPB过程中促炎细胞因子TNF—α和IL-6的释放，促进抗炎细胞因子IL-10的释放，调节促炎因子和抗炎因子之间的平衡，从而减轻体外循环期间炎症反应。

OBJECTIVE To evalute the effect of ulinastatin on the changes of inflammatory cytokines and inflammatory response resulting from cardiopulmonary bypass （CPB） in cardiac valve replacement surgery. METHODS Thirty - six patients scheduled for elective cardiac valve replacement with CPB were randomly divided into two groups of 18 each： control group （C） and ulinastatin group （U）. Group U received ulinastatin 1.2 × 10^4 U/kg and group C received same volume of normal saline instead of ulinastatin as control. Blood samples were taken from radial artery for determination of plasma TNF - α, IL -6 and IL - 10 concentrations before induction of anesthesia（T1 ）, 1 h after start of CPB （T2）, 1 h after （T3） and 24 h （T4） after termination of CPB. All of these was estimated by enzyme 2 linked immunosorbent assay （ELISA）. RESULTS There was no signif icant difference between two groups in plasma TNF -α , IL - 6 and IL - 10 level at T1. The level of TNF -α, IL -6 and IL - 10 was significantly increased at T2 -T4 compared with that before CPB（T1 ） in both groups. However, the plasma concentrations of TNF- α and IL-6 were significantly lower while the level of IL - 10 was significantly higher in group U than those in group C at T2 - T4. CONCLUSION Ulinastatin could reduce the increased amplitude of plasma levels of TNF - α and IL - 6, whereas enhance the increased amplitude of the plasma IL - 10 levels that result from CPB in cardiac valve replacement. In other word, Ulinastatin posseses the effect to regulate inflammatory cytokines balance and down -regulate inflammatory response during CPB.