浅低温体外循环心脏不停跳术对HMGB1影响临床研究

目的 探讨体外循环(CPB)对高迁移率族蛋白B1(HMGB1)影响及浅低温体外循环心脏不停跳手术肺保护机制。方法 40例二尖瓣置换患者，随机分为实验组(浅低温体外循环心脏不停跳组)与对照组(中低温心脏停跳体外循环组)，检测支气管肺泡灌洗液(BALF)中TNF-α、IL-8、HMGB1水平；检测HMGB1血清浓度；计算呼吸指数(RI)。结果 ①两组BALF中TNF-α、IL-8在CPB后30min各时点明显升高(P<0.01)，HMGB1在术后8h明显升高(P<0.01)，实验组升高明显低于对照组(P<0.01)；②两组血清中HMGB1浓度在CPB术后6h 各时点明显升高(P<0.01，P<0.05)；实验组升高明显低于对照组(P<0.01，P<0.05)；③两组RI在CPB停机时后各时点升高(P<0.01 P<0.05)，实验组升高明显低于对照组(P<0.05)。结论 HMGB1可能作为“晚期”炎性因子参与CPB术后肺损伤的病理过程；浅低温体外循环心脏不停跳手术能减轻CPB术后肺损伤机制可能与其减少HMGB1释放有关。

The clinical research on effect of operating on beating-heart with mild hypothermic cardiopulmonary bypass on HMGB1

【Abstract】　Objective To explore effect of cardiopulmonary bypass on high mobility group protein B1(HMGB1) and lung protection mechanism of operating on beating-heart with mild hypothermic cardiopulmonary bypass. Methods: 40 patients underwent mitral valve replacement were random1y divided into 2 groups, both the experimental group (operating on beating-heart with mild hypothermic cardiopulmonary bypass group) and the control group (operation on arrested heart with moderate hypothermia cardiopulmonary bypass group). The levels of TNF-α, IL-8 and HMGB1 were measured in bronchoalveolar lavage fluid (BALF)and HMGB1 in blood. Respiratory index(RI) was calculated. Result: ①The levels of TNF-α, IL-8 at 30 min after CPB and 8h after operating , HMGB1 at 8h after operating in BALF increased significantly in two groups(P<0.01). But the levels of those in the experimental group were lower significantly than in the control group(P<0.01). ②The levels of HMGB1 in blood increased significantly at different times after 6h after CPB(P<0.01 P<0.05). But levels of those in the experimental group were lower significantly than in the control group(P<0.01,P<0.05).③The level of RI at the end of CPB,1 hours and 8 hours after CPB increased significantly in two groups(P<0.01 P<0.05). but the level in the experimental group was lower significantly than in the control group(P<0.05). Conclusion: HMGB1 as a late proinflammatory cytokine participated pathological process of lung injury. lung protection mechanism of operating on beating-heart with mild hypothermic cardiopulmonary bypass was possibly related to it’s reducing HMGB1.