乌司他丁对瓣膜置换术患者粘附分子的影响

目的　探讨尿胰蛋白酶抑制剂乌司他丁 (Ulinastatin)对风湿性心脏病二尖瓣置换术患者粘附分子的影响。方法　 2 0例择期行二尖瓣置换手术的风心病患者随机分为两组 (每组 10例 ) ,乌司他丁组应用 12 0 0 0U/kg于麻醉诱导后静脉推注 ,对照组不加乌司他丁。分别在麻醉诱导后、CPB30min、手术结束时、术后第一天和第二天抽取血标本 ,用流式细胞仪测定中性粒细胞CD11b、CD18和CD11b/CD18阳性细胞百分率 ,用ELISA法测定血清中的内皮细胞表达的细胞间粘附分子 - 1(ICAM - 1)。结果　CPB30min直至术后第二天 ,对照组中性粒细胞CD11b、CD18和CD11b/CD18阳性细胞百分率均较乌司他丁组明显升高 (p <0 .0 5 ) ;术后第一天及术后第二天 ,对照组血清ICAM - 1含量较乌司他丁组明显增加 (p <0 .0 5 )。结论　乌司他丁能明显抑制风心病二尖瓣置换术患者中性粒细胞表面CD11b、CD18、CD11b/CD18以及血清ICAM - 1的表达 ,从而有效降低瓣膜置换术患者由CPB引发的炎症反应

Effects of Ulinastation on Adhesion Molecules in Patients with Rheumatic Heart Disease Unndergoing Mitral Valve Replacement

OBJECTIVE To explore the effects of ulinastatin on adhesion molecules in patients with rheumatic heart disease undergoing valve replacement. METHODS Twenty patients scheduled for elective mitral valve replacement were randomized into two groups: (1) control (n=10), or (2) venous injection of ulinastatin (12 000U/kg) after anesthesia induction (n=10). Blood samples were drawn from radial artery at baseline, 30 minutes of CPB, end of operation, 1 day after operation and 2 day after operation. Neutrophil CD11b, CD18 and CD11b/CD18 were measured by FCM. ICAM-1 in blood serum was measured by ELISA. RESULTS The institution of CPB in the patients undergoing mitral valve replacement induced up-regulation of the neutrophil CD11b, CD18, CD11b/CD18 and serum ICAM-1. There was no significante difference in baseline value. Samples from the control group demonstrated significant increases (p<0.05) in CD11b, CD18 and CD11b/CD18 positive cell percentage when compared to unlinastatin group at the same time intervals. CONCLUSION These results indicate that ulinastatin modulates the CPB-induced up-regulation of neutrophil CD11b, CD18, CD11b/CD18 and serum ICAM-1, the important indicator of the systemic inflammatory response to CPB. Therefore, these data indicate that ulinastatin is effective in reducing this inflammatory response, attenuating heart and lung reperfusion injury, protecting the function of important organs in the patients undergoing mitral valve replacement.