乌司他丁对中性粒细胞NF-κB活性及血浆TNF-a及IL-8水平影响.docVIP

乌司他丁对中性粒细胞NF-κB活性及血浆TNF-a及IL-8水平影响 　 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(cardiopulmonary bypass,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30 min(T2)、CPB停止后30 min(T3)、CPB停止后4 h(T4)和CPB停止后24 h(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PMN NF-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 PMN NF-κB活性均低于C组(Plt; 0. 05)。两组TNF-α和IL -8 水平均于手术开始后逐渐升高(Plt; 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(Plt; 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0.533(Plt; 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 lt; 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 lt; 0.05)。结论 乌司他丁可以通过降低CPB患者PMN NF - κB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-8 Abstract: OBJECTIVE To study the effects of ulinastatin on the NF -κB activity of polymorphonuclear neutrophils，TNF-a and IL-8 expression in the patients underwent cardiopulmonary bypass (CPB).METHODS Forty tetralogy of Fallot patients were randomly divided into two groups of 20 each, control group(C) and ulinastatin group (U). 5 ml blood sample took from radial artery after induction of anesthesia (T1), 30 min after CPB (T2), 30 min (T3), 4 hours (T4) and 24 hours (5) after came off CPB. NF -κB activity was tested in ELISA and expression of TNF-a and IL-8 was measured in ELISA also.RESULTS The value of NF-κB activity showed a progressive rise after starting CPB，the peak level of NF-κB activity shown at T3，then it decreased. The NF- κB activity in T2,T3,T4 and T5 of treatment group was lower than that in control group. Expression of TNF-a and IL-8 showed a progressive increase in two groups at all the 5 time points in the clinical study. The TNF-a and IL-8 expression in treatment group was lower than that in T2,T3,T4 and T5 of control group. There were significantly positive correlation among the activation of NF-κB, and serum lev