阿拓莫兰对体外循环患者中性粒细胞激活干预作用的临床研究

目的　观察阿拓莫兰对临床体外循环患儿中性粒细胞激活的干预作用。方法　随机抽取年龄 6～ 12岁先天性心脏病患儿 2 0例 ,单盲法配对分组为对照组 10例、干预组 10例 ,干预组体外循环预充液中加入阿拓莫兰 30mg/kg ,分别于术前 2 4h、体外循环开始 2 0min、复温前、体外循环结束前、术后 4h、术后 2 4h抽取静脉血 ,分离中性粒细胞 ,提取核蛋白 ,以电泳迁移率实验测定核转录因子κB活性变化 ;免疫组化检测细胞间粘附分子 (ICAM 1)的表达。结果　对照组体外循环开始 2 0min后 ,中性粒细胞核转录因子κB已被激活 ,在复温前达到峰值 ,术后 2 4h逐渐恢复至 (0 13± 0 0 4 ) (×10 6)术前水平 ;复温前ICAM 1开始表达增加 ,术后 4h达到峰值 ,术后 2 4h逐渐恢复至 (0 2 0± 0 0 9)(× 10 6)术前水平。干预组二者表达均下降 ,核转录因子κB活性于术后 4h下降为 0 12± 0 0 3(×10 6) ,ICAM 1于术后 4h下降为 2 5 2± 0 96 (× 10 6)与同时间点对照组 4 2 0± 0 82 (× 10 6)比较差异有显著意义 (P <0 0 5 )。结论　体外循环过程可激活中性粒细胞 ,中性粒细胞核转录因子κB活化 ,ICAM 1表达增强 ;阿拓莫兰可抑制中性粒细胞激活 ,减轻全身炎性反应。

The intervention of reduced glutathione in neutrophil activation in the process of extracorporeal circulation

OBJECTIVE: To study the intervention of reduced glutathione for neutrophil activation in the process of extracorporeal circulation. METHOD: 20 congenital heart disease children aged from 6 to 12 years were selected randomly, divided into control group and interventional group, patients of interventional group were added reduced glutathione (30 mg/kg) in priming fluid, then phlebotomized on the time of 24 hours before operation, 20 minutes after CPB, rewarming, the end of CPB, 4 hours after operation, 24 hours after operation. After separated neutrophil, we distilled nuclear protein and mensurated the activation of nuclear factor-kappaB by EMSA, assayed the expression of ICAM-1. by immunohistochemistry. RESULTS: Neutrophil nuclear factor-kappaB has been activated on the time of 20 minutes after CPB, arrives at the top on the time of rewarming, and resumes 24 hours after operation; ICAM-1 expresses on the time of rewarming, arrives at the top 4 hours after operation in control group. The data of interventional group is lower than the control group. CONCLUSION: Neutrophil nuclear factor-kappaB is activated and ICAM-1 is expressed in the process of extracorporeal circulation and play an important role in the inflammatory response happening in extracorporeal circulation, which could be relieved by reduced glutathione.