体外循环时心肌细胞上ICAM-1的变化及抑肽酶对其表达的影响

为观察心脏瓣膜置换术病人在CPB前后心肌上ICAM-1的表达，并探讨抑肽酶对其表达的影响，选择择期心脏瓣膜替换术病人20例，随机分为抑肽酶组和对照组，各10例。分别于手术开始及结束时取右心房心肌标本，采用免疫组化法检测心肌细胞及心肌血管内皮细胞上ICAM-1的表达，以测得ICAM-1积分光密度值（IOD值）进行分析。结果心脏瓣膜替换术病人CPB后心肌细胞上ICAM-1的表达较术前有明显增加（P<0.05）,而在抑肽酶组则无明显变化。组间比较，差异具有显著意义，P<0.05。在对照组，心肌血管EC上ICAM-1在CPB后表达明显增加（P<0.05），而抑肽酶组，差异无显著性。组间比较，P<0.05。认为CPB时心肌细胞及心肌血管EC上ICAM-1的表达增高，ICAM-1可能参与CPB时心肌的炎症损伤，抑肽酶可以通过抑制ICAM-1的表达而减轻CPB所致的炎症反应。

Change of Intercellular Adhesion Molecule-1 in Myocardium during Cardiopulmonary Bypass and Influence of Aprotinin on Its Expression

To study the expression of intercellular adhesion molecule 1(ICAM 1) in myocardium in the patients with heart valve replacement during cardiopulmonary bypass (CPB) and evaluate whether aprotinin could influence its expression, a randomized and prospective study was performed on 20 patients with heart valve replacement receiving CPB either with aprotinin (aprotinin group, n =10) or without aprotinin(control group, n =10). Atrial biopsy specimens were obtained before and after CPB. Immunohistochemistry method was used to detect the expression of ICAM 1 in cardiac myocytes and myocardial vascular endothelial cells. ICAM 1 was semiquantified. The results showed at the end of CPB, ICAM 1 in cardiac myocytes and myocardial vascular endothelial cells was significantly increased in the control group as compared with pre bypass ( P <0.05). However, there was no significant difference between pre bypass and post bypass for the expression of ICAM 1 in the aprotinin group. Furthermore, there was significant difference between the two groups ( P <0.05). It was indicated that the expression of ICAM 1 in cardiac myocytes and myocardial vascular endothelial cells was increased after CPB. ICAM 1 might participate in inflammation mediated myocardial injury which could be reduced by aprotinin inhabiting the expression of ICAM 1.