中性粒细胞凋亡与体外循环全身炎性反应相关性研究.doc

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1、中性粒细胞凋亡与体外循环全身炎性反应相关性研究作者：赵志勇，阎志军，赵砚丽，李建立，冯光兴，何荣海，高永谦，于新江【摘要】目的探讨中性粒细胞(polymorphonuclearneutrophil,PMN)凋亡与体外循环(extracorporealcirculation,ECC)全身炎性反应的相关性及意义。方法50例ECC心脏直视手术病人，于ECC前、ECC结束时、ECC结束后4h、术后第1d晨四个时点采取静脉血，以全血细胞计数仪测定PMN数量，流式细胞仪测定PMN凋亡率和PMN表面粘附分子CD

2、11b表达变化，ELISA法测定血浆弹性蛋白酶浓度，透射电镜观察PMN凋亡细胞形态学变化。结果PMN凋亡率在ECC期间明显降低，与ECC时间呈负相关。PMN数量、CD11b表达、血浆弹性蛋白酶浓度在ECC期间明显升高，与其凋亡率呈负相关，且血浆弹性蛋白酶浓度与ECC时间呈正相关。透射电镜下可见典型的PMN凋亡细胞。结论ECC导致PMN的凋亡受抑数量增加、生存周期延长、CD11b表达上调、脱颗粒释放弹性蛋白酶增加，加剧炎性反应扩散和组织损伤，炎性反应进一步迁延。【关键词】中性粒细胞；细胞凋亡；体外循

3、环；炎性反应；CD11b；弹性蛋白酶CorrelationbetweenPolymorphonuclearNeutrophilApoptosisandAbstract:OBJECTIVEToinvestigatethecorrelationandsignificancebetweenpolymorphonuclearneutrophil(PMN)apoptosisandsystemicinflammatoryresponsetoextracorporealcirculation(ECC).　MET

4、HODSFiftypatientsundergoingopenheartsurgerywithECCwerestudied.BloodsamplesweredrawnfromthecentralvenouslinebeforestartingECC,attheendoftheECC,4hoursafterECCandonthefristpostoperativemorning.ThePMNcountswereperformedbybloodcellcounter.PMNwereisolated,a

5、nditsapoptosisandtheexpressionofCD11bwereevaluatedbyflowcytometry.Theplasmaconcentrationofelastasewasdeterminedbyenzyme-linkedimmunosorbentassays.ThemorphologicalchangeofPMNapoptosiswasdetectedbytransmissionelectronmicroscope.　RESULTSTheratesofPMNapop

6、tosisweresignificantlyreducedduringECCuntilthefristpostoperativemorning,andtherateat4hoursafterECCnegativelycorrelatedwiththedurationofECC.ThePMNcounts,theexpressionofPMNCD11bandthelevelsofplasmaelastaseweremarklyincreasedduringECC,andat4hoursafterECC

7、inverselycorrelatedwithPMNapoptosisrate.PeakelastaselevelscorrelatedpositivelywiththedurationofECC.PMNapoptosiswasshowedunderelectronmicroscope.　CONCLUSIONECCsuppressPMNapoptosis,increasePMNcount,andprolongthefunctional6lifespanofPMN.TheinhibitionofPM

8、NapoptosiscauseupregulationofPMNCD11bexpressionandelevationofplasmaPMNelastaselevel,potentiateandprolongthesystemicinflammationresponseinducedbyECC.Keywords：Polymorphonuclearneutrophil；Apoptosis；Extracorporealcirculation；Systemicinflammationre