蔡秀免

[摘要] 目的 探索烏司他丁对体外循环患者中性粒细胞NF-κB活性及血浆TNF-α和IL-8水平的影响。方法 方便收集该院2016年3月—2018年3月体外循环下行心脏直视手术的法洛四联症患儿62例，随机分为研究组和对照组，每组31例。研究组给予乌司他丁，对照组给予注射生理盐水。分别在手术前、体外循环30 min后、体外循环停止后30 min、体外循环停止后4 h、体外循环停止后24 h进行抽血，用ELISA检测患者的NF-κB活性及血浆TNF-α和IL-8水平。结果 研究组患者在体外循环30 min后的NF-κB活性（0.68±0.17）ng/well显著低于对照组的（1.08±0.25）ng/well，差异有统计学意义（P<0.05）、体外循环停止后30 min的NF-κB活性（0.89±0.02）ng/well显著低于对照组的（1.22±0.02）ng/well，差异有统计学意义（P<0.05）、体外循环停止后4 hNF-κB活性（0.62±0.08）ng/well显著低于对照组的（0.94±0.02）ng/well，差异有统计学意义（P<0.05）、体外循环停止后24 h的NF-κB活性（0.65±0.07）ng/well显著低于对照组的（0.79±0.04）ng/well，差异有统计学意义（P<0.05）。研究组在体外循环停止后30 min的血浆TNF-α水平（0.86±0.06）ng/mL显著低于对照组的（1.09±0.07）ng/mL、研究组的体外循环停止后4 h的血浆TNF-α（0.65±0.06）ng/mL显著低于对照组的（1.02±0.04）ng/mL。研究组的体外循环停止后30 min的IL-8水平（0.79±0.05）ng/mL显著低于对照组的（1.02±0.05）ng/mL，差异有统计学意义（P<0.05）。研究组的体外循环停止后4 h的IL-8水平（0.75±0.05）ng/mL显著低于对照组的（0.94±0.05）ng/mL，差异有统计学意义（P<0.05）。两组的中性粒细胞NF-κB活性及血浆TNF-α和IL-8水平均呈正相关关系。结论 乌司他丁能够下调NF-κB活性来抑制血浆TNF-α和IL-8水平，从而达到抑制炎症反应。

[关键词] 乌司他丁;中性粒细胞;NF-κB;TNF-α;IL-8;体外循环

[中图分类号] R654.1          [文献标识码] A          [文章编号] 1674-0742（2019）11（a）-0076-03

Effect of Ulinastatin on Neutrophil NF-κB Activity and Plasma TNF-α and IL-8 Levels in Patients Undergoing Cardiopulmonary Bypass

CAI Xiu-mian

Department of Cardiac Surgery， the First Affiliated Hospital of Fujian Medical University， Fuzhou， Fujian Province， 350004 China

[Abstract] Objective To investigate the effects of ulinastatin on neutrophil NF-κB activity and plasma TNF-α and IL-8 levels in patients with cardiopulmonary bypass. Methods A total of 62 children with tetralogy of Fallot who underwent open heart surgery with cardiopulmonary bypass from March 2016 to March 2018 were randomly divided into study group and control group， with 31 cases in each group. The study group was given ulinastatin and the control group was given normal saline. Blood samples were taken before surgery， 30 min after cardiopulmonary bypass， 30 min after cardiopulmonary bypass， 4 h after cardiopulmonary bypass， and 24 h after cardiopulmonary bypass. ELISA was used to detect NF-κB activity and plasma TNF-α and IL-8 levels. Results The NF-κB activity （0.68±0.17）ng/well of the study group was significantly lower than that of the control group （1.08±0.25）ng/well the difference was statistically significant（P<0.05）and 30 min after the cardiopulmonary bypass （0.89±0.02）ng/well， significantly lower than the control group （1.22±0.02）ng/well the difference was statistically significant（P<0.05）， 4h NF-κB activity （0.62±0.08）ng/well was significantly lower than the control group （0.94±0.02）ng/well the difference was statistically significant（P<0.05）， cardiopulmonary bypass of NF-κB activity （0.65±0.07）ng/well at 24 h after the stop was significantly lower than that of the control group （0.79±0.04）ng/well the difference was statistically significant（P<0.05）. Plasma TNF-α levels （0.86±0.06）ng/mL were significantly lower in the study group at 30 min after cardiopulmonary bypass （1.06±0.06）ng/mL， and plasma TNF-α （0.65±0.06） was significantly higher in the study group 4 h after cardiopulmonary bypass， lower than the control group （1.02±0.04）ng/mL. The IL-8 level （0.79±0.05）ng/well at 30 min after the cardiopulmonary bypass was stopped in the study group was significantly lower than that in the control group （1.02±0.05）ng/mL the difference was statistically significant（P<0.05）. The IL-8 level （0.75±0.05）ng/mL at 4 h after the cardiopulmonary bypass was stopped in the study group was significantly lower than that in the control group （0.94±0.05）ng/mL the difference was statistically significant（P<0.05）. The neutrophil NF-κB activity and plasma TNF-α and IL-8 levels were positively correlated in both groups. Conclusion Ulinastatin can down-regulate NF-κB activity to inhibit plasma TNF-α and IL-8 levels， thus inhibiting the inflammatory response.

[Key words] Ulinastatin; Neutrophils; NF-κB; TNF-α; IL-8; Cardiopulmonary bypass

体外循环是利用一系列特殊人工装置将回行静脉血引流到体外，经人工方法进行气体交换，调节温度和过滤后，输回体内动脉系统的生命支持技术。体外循环会引起患者的炎症反应，体外循环中与人工装置的直接接触、体温变化、手术创伤等都会引起炎症反应和不同程度的损伤[1]，导致促进释放肿瘤坏死因子、白细胞介素等炎性细胞因子，进而导致组织损伤。中性粒细胞NF-κB是炎症介质的基因转录和级联放大中的作用位点，中性粒细胞NF-κB的活化能够促进心脏缺血再灌注损伤的炎症反应[2]。虽然体外循环发生严重肺损伤较少，但其发生所致的患者死亡率为50%[3]。而乌司他丁可以抑制炎性介质的产生。该文方便收集该院2016年3月—2018年3月体外循环下行心脏直视手术的法洛四联症患儿62例，探索乌司他丁对体外循环患者中性粒细胞NF-κB活性及血浆TNF-α和IL-8水平的影响，现报道如下。……