阿霉素对围麻醉期心肌肌钙蛋白Ⅰ和心肌超微结构影响的实验研究

The effect of serum cardiac troponin Ⅰ level and myocardial ultrastructure on peri-anesthesia rats after Adriamycin chemotherapy

目的研究阿霉素(ADM)化疗对大鼠围麻醉期心肌肌钙蛋白I(cTnI)水平、肌酸激酶(CK)和肌酸激酶同功酶(CKMB)活性的变化和心肌超微结构的影响,探讨围麻醉期心肌损伤的程度与特点。方法32只Wistar大鼠随机分成A、B、C、D组,每组8只。A、B组腹腔注射(ip)ADM2.50mg.kg-1,隔日1次,共6次(11d);C、D组ip相同容积的生理盐水。所有Wistar大鼠于最后一次注药后3d实施麻醉:A、C组选择吸入异氟烷麻醉;B、D组选择ip戊巴比妥钠麻醉。分别于麻醉前、麻醉后20min采血1ml,离心分离血清检测cTnI、CK和CKMB,并取出心脏制作病理和透射电镜标本。结果①4组Wistar大鼠麻醉前cTnI水平的差异无统计学意义,而麻醉后均有不同程度升高(P<0.01),A和B组、B和D组比较,差异均有统计学意义(P<0.01);B组麻醉前、后比较,差异有统计学意义(P<0.05);②4组Wistar大鼠麻醉前或后CK、CKMB值的差异均无统计学意义,麻醉前、后配对比较差异也无统计学意义(P均>0.05);③心肌病理改变:A、B组见心肌细胞变性、坏死;而C、D组结果正常,4组心肌组织病理评分差异有统计学意义(P<0.01)。结论cTnI是动态监测围麻醉期心肌损伤敏感的指标;是判断麻醉是否加重ADM化疗患者心肌损伤的重要标志。与戊巴比妥钠相比,吸入麻醉药异氟烷没有进一步加重ADM引起的心肌损伤,具有一定的心肌保护作用。

Objective To investigate the degree and characteristic of myocardial injury on peri-anesthesia wistar rats induced by Adriamycin （ADM） chemotherapy, through analysing the changes of serum cardiac troponin Ⅰ （cTnI） level, creatine kinase （CK） ,isoenzyme of creatine kinase （CKMB） activites and myocardial ultrastructure. Methods Thirty-two wistar rats were randomized into four groups ： A, B, C and D. Rats in group A and B were treated with ADM by intraperitoneal injection （ ip）, and rats in group C and D were treated with sodium chloride solution. All rats were treated with anesthesia on the third day after completing the last injection. Anesthesia treatment for the rats in group A and C were opened isoflurane inhalation, while for the rats in group B and D were sodium chloride pentobarbital solution by ip. Blood samples from all animal were taken at pre-anesthesia and 20min post-anaesthesia respectively. The hisptopathological changes of myocardium were observed with light microscope and transmission electron microscope. Results ①The differences of serum cTnl level among the four groups were not statistically significant at pre-anesthesia,but were statistically significant between group A and B ,group B and D at post-anesthesia （P 〈 0.01 ） . The cTnI levels in all of the four groups were higher at post-anesthesia than that at pre-anesthesia, with the statistical signifi- cance in Group B （ P 〈 0. 05 ）. ②The levels of serum CK and CKMB between pre-anesthesia and post-anesthesia were not statistically significant in four groups （P 〉 0.05 ）. ③ With light and electron transmission microscope, pathological changes of myocardi- um were significant between chemotherapy groups and control groups, as the severe cell degeneration and necrosis were observed in chemotherapy group. The histopathological score of myocardium was significantly different among the four groups. Conclusions Serum cTnI level is a sensitive marker of cardiac injury at peri-anesthesia,and it is more sensitive and specific than CK and CKMB levels. Serum cTnI level also is an important marker to evaluate aggravation of cardiac injury induced by anesthesia on ADM chemotherapy. Inhalation isoflurane have no significant effect on aggravating cardiac injury induced by ADM chemotherapy com- paried with sodium chloride pentobarbital,but provides certain degree of myocardial-protection effect.