葛根素预处理对小儿开心手术中血清肌钙蛋白-T及IL-6、IL-8、TNF-α浓度的影响

目的:观察和探讨葛根素(puerarin)预处理对体外循环(cardiopulmonary bypass,CPB)下小儿先天性心脏病心脏直视手术中心肌缺血再灌注损伤的防治作用及炎性反应机制。方法:选择先心病小儿20例,随机分为两组。一组为葛根素预处理观察组(观察组),一组为生理盐水对照组(对照组)。观察组于CPB前静脉输注葛根素4mg/kg,对照组输注等量生理盐水。分别于T1:CPB前(基础值);T2:主动脉开放后1h;T3:主动脉开放后2h;T4:主动脉开放后4h采集患儿全血4次,4ml/次。采用电化学发光法测定各时点血清心肌特异性肌钙蛋白T(specific myocardialtroponin T,c-TNT)浓度;采用酶联免疫吸附实验(ELISA)测定各时点致炎性细胞因子白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子α(TNF-α)。结果:观察组各时点血清c-TNT浓度均低于对照组;观察组各时点血清致炎性细胞因子IL-6、IL-8、TNF-α浓度也均低于对照组。结论:葛根素预处理可明显减轻先心病小儿开心手术中心肌缺血/再灌注损伤;抑制血清致炎性细胞因子IL-6、IL-8、TNF-α的表达可能是其心肌保护作用的炎性反应机制。

The Effect of Puerarin Which was Preconditioned on Serum Concentrations of Introponin-T,IL-6,IL-8 and TNF-in Kids' Open Heart Surgery

Objectives： To investigate the effect of puerarin on sertan concentrations of troponin-T, IL-6, IL-8, TNF-α, IL-10 and IDlra in children with congenital heart diseases （CHD） during open heart surgical procedures.Methods： 20 children with CHD and undergoing surgical correction under general anesthesia and cardiopulmonary bypass （ CPB ） were enrolled randomly into puerarin group （ n = 10） and control group （ n = 10） .In puerarin group puerarin 4 - 5mg/kg （diluted in NS 20ml） was infused intravenously with 5%GS100ml and in control group equivalent plain NS was infused in the same way after anesthesia and before CPB.4ml of whole blood samples were collected at four time points, i.e.T1, ： before CPB; T2： lh after aorta declamping; T3： 2h after aorta declamping;T4： 4h after aorta declamping.The serum concentrations of specific myocardial injury marker tropenin-T were measured by electro- chemiluminescence.The serum concentratiom of IL-6, IL-8 and TNF-α were tested by ELISA.Resuhs： Compare with T1, serum troponin T was increased markedly at T2 （ P 〈 0.05）, T3 and T4 （ P 〈 0.01 ） in control group. Compare with Tl, serum troponin T was increased markedly at T3 and T4 （ P 〈 0.05 ） in test group. Compare with T1, serum IL-6 was increased markedly at T2, T3 and T4 （ P 〈 0.01 ） in control group, but not in test group. Compare with T1, serum IL-8 and TNF-α were increased markedly at T2 and T3 （ P 〈 0.01） in control group, but not in test group.No difference was observed in serum level of troponin-T, IL-6, IL-8 and TNF-α at T, between test and control groups.Serum level of IL-6 was significantly lower at T4 （ P 〈 0.01 ） in test group comparing with the control.Serum level of IL-8 was significantly lower at T2 （ P 〈 0.05） and T3 （ P 〈 0.01 ） in test group comparing with the control.No difference was found in serum level of TNF-a at T2, T3 and T4 between test group and the control group （P〉0.05） .Conclusions： The findings in this clinical study revealed that pre-emptive use of puerarin can remarkably attenuate myocardial isehemia/reperfusion injury by inhibiting over expression of pro-inflammatory cytokines.