红景天对先天性心脏病幼儿体外循环术后炎性因子表达的影响

Effects of the integripetal rhodiola herb on the expression of inflammatory factor in infants with congenital heart disease after cardiopulmonary bypass

目的通过研究红景天对先心病幼儿体外循环(CPB)术前、中、后血浆肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)和可溶性血管细胞间黏附分子-1(sVCAM-1)水平的变化,评估红景天对幼儿CPB后炎性反应的预防与治疗价值。方法将167例先天性心脏病CPB心内直视手术患儿按双盲法随机分为红景天未干预组(CN组,n=78)和红景天干预组(CI组,n=89)。干预组于术前1d、术中、术后7d连续予以红景天1mg.kg-1.d-1,静脉滴注,其余治疗方案2组相同。ELISA法测定术前1d,CPB开始后15min,停CPB后1h,术后第1天、第3天、第5天血浆TNF-α、sICAM-1和sVCAM-1浓度。结果 2组患儿在CBP开始后15min及术后血浆TNF-α、sICAM-1和sVCAM-1浓度较术前都明显升高(P<0.01);CBP开始及术后未干预组血浆TNF-α、sICAM-1和sVCAM-1浓度明显高于干预组(P<0.01);干预组TNF-α、sICAM-1和sVCAM-1浓度较未干预组恢复正常早;TNF-α与sICAM-1、sVCAM-1之间存在正相关(r=0.671,P<0.05)。结论红景天对TNF-α与sICAM-1、sVCAM-1等炎性因子有显著调节抑制作用,对预防与治疗CPB下心脏手术患儿术后炎性反应有很好的临床实用价值。

Objective To investigate the effects of integripetal rhodiola herb on the expression of TNF-α, sICAM-1 and sVCAM-1 in serum before, during and after cardiopulmonary bypass （CPB） and on inflammatory reaction induced by CPB, and to evaluate the clinical value of integripetal rhodiola herb in preventing and treating postoperative inflammatory response induced by CPB in infants with congenital heart disease. Methods The 167 infants with congenital heart disease who underwent CPB were randomly divided into the integripetal rhodiola herb intervention group （ n = 89 ） and non-intervention group （ n = 78 ） by double blind method. The patients in intervention group received integripetal rhodiola herb Img ·kg-1· d-1 iv gtt from one day before operation to 7 days after operation, on the basis of routine therapy for non-intervention group, but the patients in non-intervention group did not receive integripetal rhodiola herb. The serum levels of TNF-α, sICAM-1 and sVCAM-1 were detected by enzyme-linked immunosorbent assay （ELISA） one day before surgery, 15 minutes after CPB, 1 hour after CPB and at lst,3rd,5th day after operation,respectively. Results The serum levels of TNF-α,sICAM-1 and sVCAM-1 during and after CPB were significantly higher than those before CPB （ P 〈0.01 ） ;in non-intervention group,the serum levels of TNF-α, sICAM-1 and sVCAM-1 during and after CPB were significantly higher than those in intervention group （ P 〈 0.01 ） ;after the operation, the intervention group showed an early recovery, as compared with that in non-intervention group, meanwhile, the serum levels of TNF-α were positively correlated with those of sICAM-1 and sVCAM-1 （ r = 0. 671, P 〈 0. 05 ）. Conclusion The integripetal rhodiola herb has obvious regulatory and inhibitory effects on the expression of TNF-α, sICAM-1 and sVCAM-1, which has great clinical value in the prevention and treatment of postoperativeinflammatory reactions induced by CPB in infants with congenital heart disease.