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1、临床医学论文•体外循环对小儿中性粒细胞凋亡及其调控蛋白的影响作者：赵砚丽，李建立，武懿，刘晓明，杜彦茹，闫志军【摘要】H的动态观察患儿在体外循环(cxfracorporcalcirculdtion,ECC)各时段外周血屮性粒细胞(polymorphonuclearneutrophi1,PMN)的凋亡率，及其脂肪酸合成酶(Fas)>B细胞淋巴瘤(Bcl-2)蛋白表达的变化规律，为临床从PMN凋亡调控入手防治ECC引发的全身炎性反应(SIRS)提供实验室依据。方法选择择期ECC下行室间隔缺损修补术的患儿30例，采用流式细胞术检测ECC前(TO),ECC开始后30min(T1)，停ECC后3
2、0min(T2),术后24h(T3)各时点静脉血屮PMN的凋亡率、Fas和Bcl-2的表达。结果与T0比较，PMN凋亡率在T2达最低值(PV0.05),与ECC持续时间呈负相关(1=・0・648,P<0.05)；与TO比较，PMN膜±Fas阳性表达百分数在T2吋点降低(P<0.05),与PMN凋亡率呈正相关(［二0.546,PV0.05)；与T0比较，Tl、T2、T3吋点PMN胞内Bcl-2阳性表达百分数升高(P<0.05),与PMN凋亡率呈负相关(=0569,P<0.05)o结论小儿ECC触发全身炎性反应的过程屮产生的多种凋亡抑制因素使PMN凋亡受到抑制，其机制与PMN的Fns表达下
3、调和Bcl-2表达上调有关。【关键词】体外循环；屮性粒细胞；细胞凋亡；脂肪酸合成酶;B细胞淋巴瘤EffectsofExtracorporealCirculationonPolymorphonuclearNeutrophi1Abstract:OBJECTIVEToinvestigatethechangesinpolymorphonuclearneutrophi1(PMN)apoptosisandFas,Bcl・2proteinexpressionofpediatricpatientsundergoingopeheartsurgerywithECC,andtogivetheexperime
4、ntalbasisfortreatingsystemicinflammatoryreactionsyndrome(SIRS).METHODSThirtypediatricpatientswithventricularseptaldefectundergoingopcheartsurgerywithECCwerestudied.Bloodsamplesweretakenafterinductionofanesthesia(TO),30minutesaftertheinitiationECC(T1),30minutesaftertheterminationECC(T2)and24hours
5、post・opcrativcly(T3).PMNapoptosisandtheexpressionofPMNFas,Bcl・2proteinweredetectedbyf1owcytomelry.RESULTSComparedwithTO,therateofPMNapoptosisreachedtoitslowestvalueatT2(P<0.05).ThepercentageofPMNapoptosiscorrelatednegativelywiththedurationofECC(t二・0.648,P<0.05).FasonPMNmembraneatT2wassignificant
6、lydownrcgulatcdthanTO.FaslevelscorrelatedposilivelywithPMNapoptosisrate(r=0.546,P<0.05).PMNintracellularexpressionofBcl・2atT1,T2,T3wassignificantlyupregulatedthanTO(P<0.05).Bel-2levelscorrelatednegativelywithPMNapoptosisrate(i--0.569,P<0.05)・CONCLUSIONThePMNapoptosiscanbedelayedbyECC.Theinhibiti
7、onofPMNapoptosishasrelationwiththedownrcgulationexpressionofFasandtheupregulationexpressionofBel-2.Keywords：Extracorporealcirculation;Polymorphonuclearneutrophi1;Apoptosis;Fattyacidsynthetase;Bcel11ymphoma・2体外循环(extracorpore
