乌司他丁对中性粒细胞NF—κB活性及血浆TNF—α和IL-8水平的影响

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—α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30min（他）、CPB停止后30min（T3）、CPB停止后4h（T4）和CPB停止后24h（T5）抽血，应用ELISA法检测NF—κB活性及血浆中TNF—α和IL-8水平。结果两组PMNNF—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、B、T4、rr5时点PMNNF—κB活性均低于C组（P〈0．05）。两组TNF-α和IL-8水平均于手术开始后逐渐升高（P〈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—α和IL-8水平在T3、T4时点均显著高于U组（p〈0．05）。U组NF—κB的活性与血浆TNF-仪水平呈正相关，相关系数为0．533（P〈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〈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〈0．05）。结论乌司他丁可以通过降低CPB患者PMNNF—κB活性进而降低血浆TNF—α和IL-8的表达，抑制体外循环后的炎症反应。

Effects of Ulinastatin on NF -κB Activity of Polymorphonuclear Neutrophils,TNF- α and IL -8 in Patients Undergoing Cardiopulmonary Bypass

OBJECTIVE To study the effects of ulinastatin on the NF - κB activity of polymorphonuclear neutrophils, TNF- α 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 - α 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 - α and IL - 8 showed a progressive increase in two groups at all the 5 time points in the clinical study. The TNF - α 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 level of TNF - α or IL - 8 in both the ulinastatin group and control group （ P 〈 0.05 ）. CONCLUSION ulinastatin can reduce the activity of NF - κB and then reduce the expression of TNF - α and IL - 8. ulinastatin can inhibit inflam- matory reaction during CPB.