肝素涂抹管道对内皮细胞激活的影响

Effect of Heparin-Coated Circuits on Endothelial Cell Activation

目的 :观察肝素涂抹体外循环 (CPB)管道对内皮细胞激活的影响。方法 :16例双瓣膜替换术患者 ,随机分为对照组 (n =8)和肝素涂抹管道组 (n =8)。分别于麻醉后CPB前、CPB 3 0min、主动脉阻断开放后 3 0min、术后第 1天和第 2天采取患者无菌血浆 ,分别刺激培养的人脐静脉内皮细胞(HUVEC) ,测定人脐静脉内皮细胞上细胞间黏附分子 1(ICAM 1)的表达及其与中性粒细胞黏附率。结果 :CPB开始后不同时点血浆刺激人脐静脉内皮细胞上ICAM 1的表达明显增高 ,其中肝素涂抹管道组明显低于对照组 ,有显著性差异 (P <0 0 5 ) ;CPB复跳后 3 0min的血浆刺激人脐静脉内皮细胞后 ,与中性粒细胞的黏附率明显增加 ,而肝素涂抹管道组明显低于对照组 ,有显著性差异 (P <0 0 5 )。结论 :肝素涂抹管道可明显抑制内皮细胞的激活 ,这可能是其抗炎作用的机制之一。

Objective: To observe the effect of heparin coated circuits (HCC) on endothelial cell activation. Methods: Sixteen patients undergoing valve replacements were included in this study. Patients were randomly divided into two groups: control group( n =8) and HCC group ( n =8). Plasma was collected from all patients 30min before and after cardiopulmonary bypass(CBP), after declamping, and at one, two days after operation. The cultured human umbilical vein endothelial cells (HUVEC) were stimulated by plasma. ELISA was used to measure the expression of ICAM 1 on HUVEC. Isotope label method was conducted to investigate the changes of PMN adhesion to HUVEC. Results: In the control group, the expression of ICAM 1 on HUVEC was higher than in the HCC group( p <0 05). The ratio of PMN adhesion to HUVEC was significantly increased compared with that in the HCC group (58 7% and 27 11%, respectively, p <0 05). Conclusions: These results indicate that heparin coated circuits can inhibit the activation of endothelial cells, and attenuate CPB induced inflammatory reaction.