左西孟旦联合高容量血液滤过对脓毒症心肌损伤患者内毒素、神经内分泌激素和炎症指标的影响

Effects of levosimendan combined with high-volume hemofiltration on endotoxin,neuroendocrine hormone and inflammatory indexes in patients with septic myocardial injury

目的观察左西孟旦联合高容量血液滤过(HVHF)对脓毒症心肌损伤患者内毒素、神经内分泌激素和炎症指标的影响。方法将2016年1月至2019年1月收治的脓毒症心肌损伤患者60例纳入研究范围,随机分为对照组和治疗组,每组30例。对照组实施早期HVHF治疗,治疗组在对照组基础上加用左西孟旦注射液。比较2组内毒素、神经内分泌激素[皮质醇(Cor)、肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)]、炎症指标[白细胞计数(WBC)、降钙素原(PCT)]、外周血单核细胞(PBMCs)Toll样受体4(TLR4)/核因子kB(NF-kB)信号通路关键分子和沉默信息调控因子1(SIRT1)表达。结果2组治疗前内毒素、Cor、ACTH、NE、AngⅡ、WBC、PCT、TLR4、NF-κB、SIRT1 mRNA和蛋白表达比较差异无统计学意义(P>0.05);2组治疗后内毒素、Cor、ACTH、NE、AngⅡ、WBC、PCT、TLR4、NF-κB mRNA和蛋白表达均较治疗前显著降低(P<0.05),SIRT1 mRNA和蛋白表达均较治疗前显著升高(P<0.05),且治疗组改善程度更明显(P<0.05)。结论左西孟旦联合HVHF治疗脓毒症心肌损伤能够通过上调SIRT1的表达抑制TLR4/NF-kB信号通路的活化,抑制炎性反应,并降低神经内分泌激素水平。

Objective To investigate the effects of levosimendan combined with high-volume hemofiltration(HVHF)on endotoxin,neuroendocrine hormones and inflammatory indexes in patients with septic myocardial injury.Methods Sixty patients with septic myocardial injury admitted from January 2016 to January 2019 were enrolled in the study,who were randomly divided into control group(n=30)and observation group(n=30).The patients in control group received early HVHF treatment,however,the patients in observation group,on the basis of the control group,were treated by levosimendan injection.The levels of endotoxin,neuroendocrine hormones[cortisol(Cor),adrenal cortex hormone(ACTH),norepinephrine(NE),angiotensinⅡ(AngⅡ)],inflammation indicators[white blood cell(WBC)count,procalcitionin(PCT)],peripheral blood mononuclear cells(PBMCs)Toll-like receptor 4(TLR4)/key molecules in nuclear factorκB(NF-κB)signaling pathway and silent information regulator 1(SIRT1)expression were observed and compared between the two groups.Results Before treatment there were no significant differences in the expression levels of endotoxin,Cor,ACTH,NE,AngⅡ,WBC,PCT,TLR4,NF-κB,SIRT1 mRNA and protein between the two groups(P>0.05).After treatment,the levels of endotoxin,Cor,ACTH,NE,AngⅡ,WBC,PCT,TLR4,NF-κB mRNA and protein expression in both groups were significantly lower than those before treatment(P<0.05),however,the levels of SIRT1 mRNA and protein expression were significantly higher than those before treatment(P<0.05).Moreover the improvement degree in observation group was more significant than that in control group(P<0.05).Conclusion Levosimendan combined with HVHF in treatment of septic myocardial injury can inhibit the activation of TLR4/NF-κB signaling pathway by up-regulating the expression of SIRT1,inhibit inflammatory response,and reduce neuroendocrine hormone levels.