白细胞过滤减轻心肌过氧化反应及心肌组织损伤

Leukocyte depletion attenuates myocardial peroxidation and myocardial injury in a porcine cardiac surgery model

目的探讨低白细胞血灌注对心肌缺血-再灌注过氧化反应及心肌组织损伤的影响。方法成年家猪12只,分成对照组(n=6)和白细胞过滤组(n=6)。两组动物采用相同的体外循环(ECC)及心肌保护液灌注装置。白细胞过滤组在ECC动脉及心肌保护液灌注管路上安装Pall LG-6白细胞滤器,白细胞滤器使用时间为心脏复灌前10 min至ECC结束;心肌保护液灌注均经白细胞滤器。心肌血流阻断60 min后开放升主动脉阻断钳,后并行辅助循环25 min后撤离ECC。结果白细胞过滤显著降低了循环血及心肌保护液中中性粒细胞计数。低白细胞血心肌保护液灌注和缺血后心脏复灌:①显著减少了复灌早期肌酸激酶同工酶及心肌钙蛋白I血浆泄漏;②显著降低了缺血期和复灌早期血浆及心肌组织丙二醛浓度;③对血浆和心肌组织超氧化物歧化酶活力分别有明显和一定程度的抑制作用。结论低白细胞血心肌保护液灌注和缺血后心脏复灌,通过抑制心肌组织过氧化反应显著减轻了心肌组织缺血-再灌注损伤,并对氧自由基清除机制有一定保护作用。

OBJECTIVE To investigate the effects of leukocyte depletion on lipid peroxidation and myocardial injury during cardiac ischemia and reperfusion period.METHODS Twelve farm pigs were used for this study.Animals were allocated to a leukocyte-depleted group（LD group） or a control group（N=6）.Identical extracorporeal circulation（ECC） circuit,membrane oxygenator,and cardiopleia device were used in both groups.Pall LG-6 leukocyte depleting filter was connected to the ECC arterial and cardioplegia delivery line in the LD group.The LD group received leukocyte-filtered blood cardioplegia,and circulating leukocyte depleting filtration from 10 minutes before myocardial reperfusion to termination of ECC.All animals received 60 minutes cold cardioplegic ischemia,and followed by 25 minutes of reperfusion on ECC.Plasma levels of creatine kinase MB（CK-MB）,cardiac troponin I（cTnI）,Malondialdehyde（MDA） plasma,myocardial concentration,superoxide dismutase（SOD） plasma,and myocardial activities were assessed.RESULTS Neutronphil counts were significantly reduced in blood cardioplegic solution and circulating blood after depleting filtration.Leukocyte-filtered blood cardioplegia/reperfusion significantly reduced the leakage of CK-MB and cTnI.Plasma MDA and myocardial concentrations were significantly lower in the LD group during ischemia and early reperfusion period.Leukopenic cardioplegia and myocardial reperfusion decreased plasma SOD level significantly or myocardial activity slightly.CONCLUSIONLeukocyte-filtered blood cardioplegia/reperfusion substantially attenuate myocardial ischemia-reperfusion injury associated with peroxidation,and may provide preservation for innate oxidative defense screen.