乌司他丁对体外循环下中性粒细胞凋亡与呼吸爆发的影响

目的观察体外循环（CPB）心脏手术患者中性粒细胞（PMN）凋亡、呼吸爆发的变化及乌司他丁对其影响。方法选择在CPB下行瓣膜置换术患者62例，随机分成乌司他丁组（U组）和对照组（c组），每组各31例。U组患者于麻醉诱导后给予乌司他丁，C组患者则给予等容积的0．9％NaCl溶液。分别于麻醉后手术前（T1）、CPB开始后30min（T2）、CPB停止后30min（T3）抽取动脉血，分离PMN，检测PMN凋亡率，呼吸爆发以及血浆中超氧化物歧化酶（SOD）和丙二醛（MDA）的水平。结果C组PMN凋亡率在T1为（66．57±5．93）％，T2为（55．37±3．51）％，T，为（48．92±4．21）％，T2、T1均较T1显著降低（P〈0．05），并于L达最低值；U组PMN凋亡率在T。为（73．57±7．94）％，T2为（68．34±4．92）％，T3为（62．13±4．76）％，T2、L均较T1显著降低（P〈0．05），并于T3达最低值；C组PMN凋亡率显著低于U组（P〈0．05）。两组PMN呼吸爆发均表现为CPB开始后逐渐升高，L达到峰值；U组T2（1105．94±84．15）MCF，T3（1156．52±93．20）MCF，与C组T2（1266．06±99．55）MCF，T3（1422．50±89．75）MCF比较明显降低（P〈0．05）。两组SOD均于手术开始后逐渐下降（P〈0．05），C组T3SOD为（47．39±6．07）μU／L显著低于U组的（51．35±6．22）μU／L（P〈0．05）。两组MDA均于手术开始后逐渐升高（P〈0．05），L达高峰，C组为（13．72±1．15）μmol／L，U组为（8．40±0．88）μmol／L，C组显著高于U组（P〈0．05）。结论CPB引起PMN凋亡率降低、凋亡延迟，呼吸爆发增强，乌司他丁能有效地促进过度激活的PMN凋亡、抑制PMN呼吸爆发，提高SOD，降低MDA，减轻CPB对机体的炎性反应及氧化损伤，对机体具有保护作用。

Effect of ulinastatin on the apoptosis of neutrophil and respiratory burst of neutrophil during cardiopulmonary bypass

Objective To investigate the change of the neutrophil apoptosis and neutrophil respiratory burst in the patients and the effect of ulinastatin on the apoptosis of neutrophil and respiratory burst of neutrophil during cardiopulmonary bypass （CPB）. Methods Sixty-two patients undergoing valve replacement with CPB were randomly divided into two groups： ulinastatin group （U group, 31 cases） and control group （C group, 31 cases）. In U group patients received ulinastatin after induction of anesthesia. In C group patients received equal volume of normal saline, instead of ulinastatin. Arterial blood was obtained before operation （%）, 30 min after the start of CPB （T2）, 30 min after the termination of CPB （T3）. The apoptosis of neutrophil and respiratory burst of neutrophil were measured by flow cytometer. The level of superoxide dismutase （SOD） and malondialdehyde （MDA） were measured by kit. Results In C group, compared with T1 （66.57 ± 5.93 ）% 1, the rate of the apoptosis of neutrophil was significantly decreased at T2 （55.37 ±3.51 ） % ] and T3 （48.92± 4.21 ） % ] （P 〈 0.05 ）. And in U group, compared with T4 （73.57 ± 7.94）% ], the rate of the apoptosis of neutrophil was significantly decreased at T2 （68.34 ± 4.92）% ] and T3 （62.13± 4.76）% ]（P 〈 0.05）, And it reached to the minimum at T3. The rate of the neutmphil apoptosis was significantly lower in C group than that in U group （P 〈 0.05 ）. The respiratory burst of neutrophil increased significantly after the start of CPB and reached to the peak at T3 C group （ 1422.50 ± 89.75 ） MCF, U group （ 1156.52 ± 93.20） MCF ]. The respiratory burst of neutrophil in U group was significantly lower than that in C group at T2 and T3 （P 〈 0.05 ）. The vitality of SOD decreased significantly after the start of operation in the two groups （P 〈 0.05 ）. The level of MDA increased significantly after the start of operation in the two groups, and reached to the peak at T3. The vitality of SOD in C group was significantly lower than that in U group at T3 （P 〈 0.05）. The level of MDA in C group was significantly higher than that in U group at T3 （P 〈 0.05）. Conclusions The rate of neutrophil apoptosis decreased mid the respiratory burst of neutrophil increased during CPB. By improving the apoptosis of neutrophil and reducing the respiratory burst of neutrophil, ulinastatin can inhibit inflammatory reaction during CPB. Meanwhile, ulinastatin can improve the vitality of SOD and reduce the level of MDA. In conclusion, ulinastatin has a significant protective effect during CPB.