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1、乌司他丁对中性粒细胞NF-κB活性及血浆TNF-a和IL-8水平的影响作者:李建立,赵砚丽,李喜龙,赵志勇,刘晓明,闫志军【摘要】目的观察乌司他丁对体外循环(cardiopulmonarybypass,CPB)患者中性粒细胞(PMN)核因子κB(NF-κB)活性及血浆中TNF-a和IL-8水平的影响。方法选择在体外循环下行心脏直视手术的法洛四联症患儿40例,随机分成乌司他丁组(U组)和对照组(C组),每组20例。U组于麻醉诱导后给予乌司他丁,C组患者则给予等容积的生理盐水代替。分别于麻醉后手术前(T1)、CPB开始后30min(T2)、CPB停止后30min(T3)、CPB停
2、止后4h(T4)和CPB停止后24h(T5)抽血,应用ELISA法检测NF-κB活性及血浆中TNF-a和IL-8水平。结果两组PMNNF-κB活性在CPB开始后逐渐升高,T3时达到峰值,之后逐渐下降,但在T5时点依然高于术前水平;U组在T2、T3、T4、T5时点PMNNF-κB活性均低于C组(P<0.05)。两组TNF-α和IL-8水平均于手术开始后逐渐升高(P<0.05),T3达高峰,之后逐渐下降,在T5时点基本恢复正常;C组TNF-a和IL-8水平在T3、T4时点均显著高于U组(P<0.05)。U组NF-κB的活性与血浆TNF-α水平呈正相关,相关系数为
3、0.533(P<0.05);NF-κB的活性与血浆IL-8水平亦呈正相关,相关系数为0.528(P<0.05)。C组NF-κB的活性与血浆TNF-α、IL-8水平亦呈正相关,相关系数分别为0.531、0.512(P<0.05)。结论乌司他丁可以通过降低CPB患者PMNNF-κ11B活性进而降低血浆TNF-a和IL-8的表达,抑制体外循环后的炎症反应。【关键词】乌司他丁;心肺转流术;中性粒细胞;核因子κB;TNF-a;IL-8Abstract:OBJECTIVETostudytheeffectsofulinastatinontheNF-κBactivityof
4、polymorphonuclearneutrophils,TNF-aandIL-8expressioninthepatientsunderwentcardiopulmonarybypass(CPB).METHODSFortytetralogyofFallotpatientswererandomlydividedintotwogroupsof20each,controlgroup(C)andulinastatingroup(U).5mlbloodsampletookfromradialarteryafterinductionofanesthesia(T1),30minafter
5、CPB(T2),30min(T3),4hours(T4)and24hours(5)aftercameoffCPB.NF-κBactivitywastestedinELISAandexpressionofTNF-aandIL-8wasmeasuredinELISAalso.RESULTSThevalueofNF-κBactivityshowedaprogressiveriseafterstartingCPB,thepeaklevelofNF-κBactivityshownatT3,thenitdecreased.TheNF-κBactivityinT2,T3,T4andT5of
6、treatmentgroupwaslowerthanthatincontrolgroup.ExpressionofTNF-aandIL-8showedaprogressiveincreaseintwogroupsatallthe5timepointsintheclinicalstudy.TheTNF-aandIL-8expressionintreatmentgroupwaslowerthanthatinT2,T3,T4andT5ofcontrolgroup.11Thereweresignificantlypositivecorrelationamongtheactivatio
7、nofNF-κB,andserumlevelofTNF-αorIL-8inboththeulinastatingroupandcontrolgroup(P<0.05).CONCLUSIONulinastatincanreducetheactivityofNF-κBandthenreducetheexpressionofTNF-aandIL-8.ulinastatincaninhibitinflammatoryreactionduringCPB.Keywords:Ulinastatin;Cardio