前列腺素E1降低心脏瓣膜置换术患者心肌细胞NF-κB活性及血浆TNF-α水平

Effects of prostaglandin E1 on the levels of myocardium NF-κB and plasma TNF-αin patients underwent heart valve replacement

目的 评价前列腺素E1（PGE1）对心脏瓣膜置换术患者心肌细胞核转录因子κB（NF-κB）活性和血浆肿瘤坏死因子α（TNF-α）水平的影响。方法 择期行体外循环下心脏瓣膜置换术的患者40例,年龄32~67岁,体质量指数17~28kg/m^2,美国麻醉师协会（ASA）分级Ⅱ或Ⅲ级,纽约心脏病协会（NYHA）分级Ⅱ或Ⅲ级。采用随机数字表法,将患者分为2组（n=20）：对照组（C组）和PGE1组（P组）。麻醉诱导后P组静脉输注PGE1 20ng·kg^-1·min^-1,至手术结束,C组给予等容量生理盐水。于体外循环前（T0,基础值）、体外循环开始后30min（T1）、体外循环结束时（T2）、体外循环结束后12h（T3）、体外循环结束后24h（T4）抽取动脉血,检测血浆TNF-α水平;于T0和T2时取右心耳组织,观察组织病理学变化,并用蛋白免疫印迹法（Western blot）检测NF-κB活性。结果 与C组比较,P组T1~T4时血浆TNF-α水平下降（P〈0.05）,T2时心肌病理学损伤明显减轻,心肌细胞NF-κB活性下降（P〈0.05）。结论 PGE1可减轻心脏瓣膜置换术患者心肌损伤,其机制与抑制心肌细胞NF-κB活性,减少血浆TNF-α水平有关。

Objective To investigate the effects of prostaglandin E1 （PGE1） on the levels of myocardium nuclear factor-κB （NF-κB） and plasma tumor necrosis factor-α （TNF-α） in patients underwent heart valve replacement. Methods Forty ASA Ⅱ or Ⅲ degree patients （NYHA Ⅱ or Ⅲ degree） ,aged 32 to 67 years with body mass index of 17 to 28 kg/m^2 ,underwent heart valve replacement, were randomly divided into 2 groups （n= 20） ：control group （group C） and PGE1 group （group P）. After induction of anesthesia, PGE1 20 ng · kg^-1 · min^-1 was infused intravenously in group P, while the equivalent volume of normal saline was giv- en in group C,and the infusion was completed at the end of operation. Arterial blood samples were collected at the time of before cardiopulmonary bypass （To ,baseline）. 30 rain after the begin of cardiopulmonary bypass （T1）, the end of cardiopulmonary bypass （T2） ,and 12 h（T3）,24 h（T4 ） after the end of cardiopulmonary bypass. Myocardial specimens were obtained from right auricular appendage at To and T2 for microscopic examination and determination the activity of NF-κB. Results The plasma mass concentra- tions of TNF-α was significantly lower （P〈0.05） at T1 to T4, while the myocardial histopathological damage was lighter and the activity of NF-κb significantly attenuated （P〈0.05） at T2 in group P than that in group C. Conclusion PGE1 can attenuate myocardial injury in patients underwent heart valve replacement, the mechanism ts related to inhibit the activity of myocardium NF-~B and decrease the plasma mass concentrations of TNF-α.