体外循环中抑肽酶对内皮细胞激活的影响

Effect of Aprotinin on Endothelial Cell Activation in Cardiopulmonary Bypass

目的 观察体外循环 (CPB)时抑肽酶 (APR)对内皮细胞 (EC)激活影响。方法 16例双瓣膜替换术病人 ,随机分为对照组 (n =8)和APR组 (n =8,3× 10 6kIU) ,分别于麻醉后CPB前、CPB 30min、开放后 30min、术后第 1和第 2天采取病人无菌血浆 ,分别刺激培养的人脐静脉内皮细胞 (HUVEC) ,测定HUVEC上细胞间黏附分子 1(ICAM 1)的表达及其与中性粒细胞 (PMN)黏附率。结果 CPB开始后不同时点血浆刺激HUVEC上ICAM 1的表达明显增高 ,其中APR组明显低于对照组 (P <0 .0 5 ) ;CPB复跳后 30min的血浆刺激HUVEC后 ,与PMN的黏附率明显增加 ,而APR组明显低于对照组 (分别为 34.2 %和 5 8.7% ,P <0 .0 5 )。结论 APR可明显抑制EC的激活 。

Purpose: To observe the effect of aprotinin (APR) on endothelial cell (EC) activation. Methods: Sixteen patients undergoing valve replacements were included in this study. Patients were randomly divided into two groups (n = 8): control group and APR group (APR 3 × 106 (kIU). The plasma were collected from all patients before operation, CPB 30 min, 30 min after declamping, post operation day 1 and 2 (POD1, POD2). Human umbilical vein endothelial cells were cultured, Cell-ELISA was used to measure the expression of ICAM-1 on HUVEC, which was stimulated by plasma. Isotope label method was conducted to investigate the changes of PMN adhesion to HUVEC, which was stimulated in the plasma from 30 min after declamping. Results: In the control group, the expression of ICAM-1 on HUVEC was higher than in the APR group(P<0.05). Plasma from control group increased PMN adhesion to HUVEC significantly compared with those in APR(34.2% and 58.7%, respectively, P<0.05). Conclusions: Aprotinin could inhibit the activation of EC, and attenuate CPB-induced inflammatory response.