乌司他丁对体外循环心脏手术后心肌损伤及缺血再灌注相关病理环节的影响

Effect of ulinastatin on the myocardial injury and ischemia reperfusion-related pathological links after cardiopulmonary bypass surgery

目的:研究乌司他丁对体外循环心脏手术后心肌损伤及缺血再灌注相关病理环节的影响。方法:选择在四川省绵阳市中心医院进行体外循环下瓣膜置换术的患者作为研究对象,随机分为接受乌司他丁+磷酸肌酸钠干预的实验组、接受磷酸肌酸钠干预的对照组。手术前及手术后24小时,测定血清中心肌损伤标志物、凋亡分子、炎症分子、氧化应激分子的含量及外周血中炎症分子、氧化应激分子的表达强度。结果:两组手术后血清中cTnI、CK-MB、H-FABP、sFasL、sTWEAK、Caspase-3、Caspase-8、IL-1β、TNF-α、ICAM1、MDA、NO的含量及外周血中TLR4、NLRP3、NOX2、iNOS的表达强度均较手术前显著升高且实验组患者手术后血清中cTnI、CK-MB、H-FABP、sFasL、sTWEAK、Caspase-3、Caspase-8、IL-1β、TNF-α、ICAM1、MDA、NO的含量及外周血中TLR4、NLRP3、NOX2、iNOS的表达强度均显著低于对照组。结论:乌司他丁对体外循环心脏手术后心肌损伤及缺血再灌注相关的细胞凋亡、炎症反应、氧化应激反应均具有改善作用。

Objective：To study the effect of ulinastatin on the myocardial injury and ischemia reperfusion-related pathological links after cardiopulmonary bypass surgery.Methods：The patients who underwent valve replacement under cardiopulmonary bypass between February 2015 and December 2017 in Mianyang Central Hospital of Sichuan Province were chosen as the research subjects and randomly divided into the experimental group who accepted ulinastatin＋creatine phosphate sodium intervention and the control group who accepted creatine phosphate sodium intervention.The levels of myocardial injury markers,apoptosis molecules,inflammation molecules and oxidative stress molecules in serum as well as the expression intensity of inflammation molecules and oxidative stress molecules in peripheral blood were determined before surgery and 24 hours after surgery.Results：Serum cTnI,CK-MB,H-FABP,sFasL,sTWEAK,Caspase-3,Caspase-8,IL-1β,TNF-α,ICAM1,MDA and NO levels as well as peripheral blood TLR4,NLRP3,NOX2 and iNOS expression intensity of both groups of patients after surgery were significantly higher than those before surgery,and serum cTnI,CK-MB,H-FABP,sFasL,sTWEAK,Caspase-3,Caspase-8,IL-1β,TNF-α,ICAM1,MDA and NO levels as well as peripheral blood TLR4,NLRP3,NOX2 and iNOS expression intensity of experimental group after surgery were significantly lower than those of control group.Conclusion：Ulinastatin can improve the myocardial injury as well as ischemia reperfusion-related apoptosis,inflammation and oxidative stress after cardiopulmonary bypass surgery.