体外循环前后胎盘生长因子及其受体的变化

目的:观察体外循环(CPB)下心脏手术中心肌组织胎盘生长因子(PlGF)及其受体(Flt-1)蛋白表达与血浆浓度变化。方法:于CPB开始及CPB结束即刻取右房组织,应用免疫组织化学法检测PlGF和Flt-1蛋白表达。于麻醉后、主动脉阻断即刻、主动脉开放后10min,术后2h、4h、24h、3d采血,ELISA法检测血浆PlGF和Flt-1的浓度。结果:CPB前后心肌均有PlGF和Flt-1蛋白表达,其表达主要位于心肌细胞,CPB后表达明显增强(P<0.05)。其血浆蛋白浓度在CPB中明显升高,主动脉阻断即刻及主动脉开放后10min明显高于其他各点(P<0.05),而2点间差异无统计学意义(P>0.05),PlGF峰值出现在主动脉阻断即刻,Flt-1峰值出现在主动脉开放后10min。回到ICU后2h即降至麻醉后水平。血浆峰值浓度与心肌蛋白表达强度无明显相关性。结论:CPB下心脏手术导致心肌PlGF和Flt-1蛋白表达增强,血浆浓度短暂升高。CPB可能是导致血浆浓度升高的主要原因,心脏的缺血再灌注不是产生它们的主要原因,心肌不是其主要来源。

Variations of placental growth factor and its receptor Fit-1 before and after cardiopulmonary bypass

Objective:To explore the changes of placental grouth fastor(PlGF) and its receptor Flt-1 protein in myocardial tissue and plasma of patients after cardiopulmonary bypass(CPB) operation.Method:Part of right atria tissue was collected just before beginning and termination of CPB.The expressions of PIGF and Flt-1 in atria were detected by immunohistochemical methods.The plasma concentration of PlGF and Flt-1 were measured by ELISA.Blood were collected after anesthesia,immediately after aorta cross clamp,10 minutes after cross-clamp release,2 hours,4 hours,24 hours and 3 days after operation.Result:PlGF and Flt-1 protein were expressed in cardiac myocytes both before and after CPB with a significant increase after CPB(P<0.05).The concentrations of plasma PlGF and sFlt-1 increased significantly in CPB.The concentrations were sagnificantly higher at the time immediately after aorta cross clamp and 10 minutes after cross-clamp release compared to the other times(P<0.05).There were no significant differences between them(P>0.05).PlGF peaked immediately after aorta cross clamp and sFlt-1 peaked 10 minutes after aorta cross-clamp release.Both of them decreased to level of anaesthesia at 2 hours back in ICU.There was no significant relationship between expressions of myocardial protein and its peak concentrations.Conclusion:The expressions of PlGF and Flt-1 in myocardia increased significantly and plasma concentrations increase transiently after heart operations under CPB.Neither ischemia or reperfusion but CPB may be the major cause of increases.The myocardia were not the major sources.