体外循环时心肌组织黏附分子的表达及抑肽酶对其的影响

Expression of Adhesion Molecule of Myocardial Tissue during Cardiopulmonary Bypass and Influence of Aprotinin

目的 观察体外循环前后P -选择素及细胞间黏附分子 - 1(ICAM 1)的表达 ,并探讨抑肽酶对其表达的影响。方法 2 0例行体外循环心内直视手术的先天性心脏病患儿 ,治疗组 10例 ,预充液中加入抑肽酶 10万kIU/kg ;对照组 10例 ,未用抑肽酶。于体外循环前后各取右心耳组织 ,采用免疫组化法检测心肌组织中P -选择素、ICAM 1及髓过氧化物酶 (MPO)的表达水平。结果 两组P -选择素、ICAM 1及MPO免疫组化灰度值术后均较术前增高 (P <0 .0 1) ;术后治疗组中其升高幅度明显低于对照组 (P <0 .0 1)。结论 体外循环心肌组织黏附分子P -选择素及ICAM 1表达增加。抑肽酶可以通过抑制这些黏附分子的表达 。

Purpose: To observe the expression of P-selectin and intercellular adhesion moleucle-1(ICAM-1) of myocardial tissue during cardiopulmonary bypass (CPB), and to evaluate the effect of aprotinin. Methods: In a randomized, prospective study, 20 patients with congenital heart disease undergoing CPB, were divided into two groups: aprotinin group (n=10,100,000 kIU/kg[100 000 kallikrein inactivator units per kilogram] in the priming volume) and control group (n = 10). Atrial biopsy specimens were obtained before and after CPB. The expression of P-selectin, ICAM-1 and myeloperoxidase (MPO) in myocardial tissue were detected by immunohistochemistry. Results: At the end of CPB, the expression of P-selectin, ICAM-1 and MPO in myocardial tissue in both groups were significantly increased compared with that of prebypass (P<0.01), but the increasing degree of them in aprotinin group was significantly lower than that in control group (P< 0.01). Conclusions: The expression of P-selectin, ICAM-1 of myocardial tissue increases during cardiopulmonary bypass. Aprotinin may reduce inflammatory response by inhibiting the expression.