中国循环杂志
中國循環雜誌
중국순배잡지
CHINESE CIRCULATION JOURNAL
2014年
10期
819-822
,共4页
曾庆玲%唐培佳%徐月秀%梁勇升
曾慶玲%唐培佳%徐月秀%樑勇升
증경령%당배가%서월수%량용승
乌司他丁%婴幼儿%体外循环%抗炎%肺功能
烏司他丁%嬰幼兒%體外循環%抗炎%肺功能
오사타정%영유인%체외순배%항염%폐공능
Ulinastatin%Infants%Cardiopulmonary bypass%Anti-inlfammation%Pulmonary function
目的：探讨乌司他丁对婴幼儿体外循环时的抗炎和肺功能保护作用及其机制。方法：选取婴幼儿心内直视手术的室间隔缺损患儿38例，随机分为两组，给予20000 U/kg剂量的乌司他丁者为乌司他丁组（n=20）和给予等量生理盐水者为对照组（n=18）。观察患儿的临床相关指标，检测切皮前5min（T1）、主动脉开放时（T2）、术后4 h（T3）和术后24 h（T4）四个时间点血清肿瘤坏死因子α（TNF-α）、白细胞介素-2（IL-2）和白细胞介素-10（IL-10）水平，术后24 h患儿的CD4+CD45+ T细胞水平和调节性T细胞（CD4+Foxp3+ T）水平，并对患儿的四个时间点的呼吸指数和氧合指数四个时间点进行比较。结果：乌司他丁组在T2、T3和T4三个时间点的TNF-α、IL-2水平明显低于对照组，IL-10水平明显高于对照组；乌司他丁组在T2、T3和T4三个时间点的氧合指数明显高于对照组，呼吸指数明显低于对照组；乌司他丁组的患儿的CD4+CD45+ T细胞所占淋巴细胞的百分比[（35.98±3.67）%]较对照组[（41.94±4.56）%]降低，调节性T细胞（CD4+Foxp3+ T）所占淋巴细胞的百分[（19.65±3.45）%]较对照组[（6.45±1.47）%]升高。上述比较差异均有统计学意义（P<0.05~P<0.01）。结论：婴幼儿体外循环时应用乌司他丁会促进CD4+CD45+ T细胞向调节性T细胞（CD4+Foxp3+ T）的分化，从而下调机体的炎症水平，对患儿的肺功能起保护性作用。
目的：探討烏司他丁對嬰幼兒體外循環時的抗炎和肺功能保護作用及其機製。方法：選取嬰幼兒心內直視手術的室間隔缺損患兒38例，隨機分為兩組，給予20000 U/kg劑量的烏司他丁者為烏司他丁組（n=20）和給予等量生理鹽水者為對照組（n=18）。觀察患兒的臨床相關指標，檢測切皮前5min（T1）、主動脈開放時（T2）、術後4 h（T3）和術後24 h（T4）四箇時間點血清腫瘤壞死因子α（TNF-α）、白細胞介素-2（IL-2）和白細胞介素-10（IL-10）水平，術後24 h患兒的CD4+CD45+ T細胞水平和調節性T細胞（CD4+Foxp3+ T）水平，併對患兒的四箇時間點的呼吸指數和氧閤指數四箇時間點進行比較。結果：烏司他丁組在T2、T3和T4三箇時間點的TNF-α、IL-2水平明顯低于對照組，IL-10水平明顯高于對照組；烏司他丁組在T2、T3和T4三箇時間點的氧閤指數明顯高于對照組，呼吸指數明顯低于對照組；烏司他丁組的患兒的CD4+CD45+ T細胞所佔淋巴細胞的百分比[（35.98±3.67）%]較對照組[（41.94±4.56）%]降低，調節性T細胞（CD4+Foxp3+ T）所佔淋巴細胞的百分[（19.65±3.45）%]較對照組[（6.45±1.47）%]升高。上述比較差異均有統計學意義（P<0.05~P<0.01）。結論：嬰幼兒體外循環時應用烏司他丁會促進CD4+CD45+ T細胞嚮調節性T細胞（CD4+Foxp3+ T）的分化，從而下調機體的炎癥水平，對患兒的肺功能起保護性作用。
목적：탐토오사타정대영유인체외순배시적항염화폐공능보호작용급기궤제。방법：선취영유인심내직시수술적실간격결손환인38례，수궤분위량조，급여20000 U/kg제량적오사타정자위오사타정조（n=20）화급여등량생리염수자위대조조（n=18）。관찰환인적림상상관지표，검측절피전5min（T1）、주동맥개방시（T2）、술후4 h（T3）화술후24 h（T4）사개시간점혈청종류배사인자α（TNF-α）、백세포개소-2（IL-2）화백세포개소-10（IL-10）수평，술후24 h환인적CD4+CD45+ T세포수평화조절성T세포（CD4+Foxp3+ T）수평，병대환인적사개시간점적호흡지수화양합지수사개시간점진행비교。결과：오사타정조재T2、T3화T4삼개시간점적TNF-α、IL-2수평명현저우대조조，IL-10수평명현고우대조조；오사타정조재T2、T3화T4삼개시간점적양합지수명현고우대조조，호흡지수명현저우대조조；오사타정조적환인적CD4+CD45+ T세포소점림파세포적백분비[（35.98±3.67）%]교대조조[（41.94±4.56）%]강저，조절성T세포（CD4+Foxp3+ T）소점림파세포적백분[（19.65±3.45）%]교대조조[（6.45±1.47）%]승고。상술비교차이균유통계학의의（P<0.05~P<0.01）。결론：영유인체외순배시응용오사타정회촉진CD4+CD45+ T세포향조절성T세포（CD4+Foxp3+ T）적분화，종이하조궤체적염증수평，대환인적폐공능기보호성작용。
Objective: To explore the effect of ulinastatin on anti-inflammation and pulmonary function protection with its mechanism for infants at cardiopulmonary bypass surgery. Methods: A total of 38 infants with ventricular septal defect undergoing cardiac operation were randomly divided into 2 groups. Ulinastatin group, the patients received uliastatin 20 000 U/kg,n=20 and Control group, the patients received the same volume of normal saline,n=18. The serum levels of TNF-α, IL-2, IL-l0 were examined at 4 time points: 5 min before skin incision (T1), immediate opening of aorta (T2), 4 hours after operation (T3) and 24 hours after operation (T4). The expressions of CD4+CD45+ T cells and CD4+Foxp3+ T cells were measured at T4. The respiratory index and oxygenation index at 4 time points were compared between 2 groups. Results: Compared with Control group, Ulinastatin group had the lower levels of TNF-α, IL-2 and higher level of IL-l0 at T2, T3, T4; Ulinastatin group also had the higher oxygenation index and lower respiratory index at T2, T3, T4, allP<0.05. Ulinastatin group had less expression of CD4+CD45+ T cells (35.98 ± 3.67)% than Control group (41.94 ± 4.56)% , and more expression of CD4+Foxp3+ T cells (19.65 ± 3.45)% than Control group (6.45 ± 1.47)%,P<0.05-P<0.01. Conclusion: Ulinastatin may improve the differentiation from CD4+CD45+ T cell to Foxp3+CD4+ T cell, down regulating inlfammatory response and protecting pulmonary function for infants at cardiopulmonary bypass surgery.
