CAJ | 학술논문

目的评价Fas/FasL信号通路在乌司他丁后处理减轻CPB下心脏瓣膜置换术患者心肌细胞凋亡中的作用.方法择期CPB下心脏瓣膜置换术患者40例,性别不限,年龄21～ 59岁,心功能和ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将患者分为2组(n=20):对照组(C组)和乌司他丁后处理组(U组).U组于主动脉开放前5 min经主动脉根部灌注乌司他丁4 000～5 000 U·kg-1 ·min-1(剂量1万U/kg);C组给予等容量生理盐水.于升动脉开放后45 min时取右心耳心肌组织,检测Fas、Fas配体(FasL)、caspase-8、Bcl-2、Bax表达和细胞凋亡情况,并计算Bcl-2与Bax表达的比值(Bcl-2/Bax).结果与C组比较,U组心肌组织Fas、FasL、caspase-8及Bax表达下调,心肌组织Bcl-2表达上调,Bcl-2/Bax升高,凋亡指数降低(P＜0.05).结论乌司他丁后处理通过抑制Fas/FasL信号通路减轻CPB下心脏瓣膜置换术患者心肌细胞凋亡.
목적 평개Fas/FasL신호통로재오사타정후처리감경CPB하심장판막치환술환자심기세포조망중적작용.방법 택기CPB하심장판막치환술환자40례,성별불한,년령21～ 59세,심공능화ASA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장환자분위2조(n=20):대조조(C조)화오사타정후처리조(U조).U조우주동맥개방전5 min경주동맥근부관주오사타정4 000～5 000 U·kg-1 ·min-1(제량1만U/kg);C조급여등용량생리염수.우승동맥개방후45 min시취우심이심기조직,검측Fas、Fas배체(FasL)、caspase-8、Bcl-2、Bax표체화세포조망정황,병계산Bcl-2여Bax표체적비치(Bcl-2/Bax).결과 여C조비교,U조심기조직Fas、FasL、caspase-8급Bax표체하조,심기조직Bcl-2표체상조,Bcl-2/Bax승고,조망지수강저(P＜0.05).결론 오사타정후처리통과억제Fas/FasL신호통로감경CPB하심장판막치환술환자심기세포조망.
Objective To evaluate the role of Fas/FasL signaling pathway in ulinastatin postconditioning-induced attenuation of apoptosis in the myocardial cells of patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty patients of both sexes,aged 21-59 yr,of ASA physical status Ⅱ or Ⅲ (NYHA class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into 2 groups (n =20 each):control group (group C),and ulinastatin postconditioning group (group U).In group U,ulinastatin 10 000 U/kg was perfused via the aortic root at 4 000-5 000 U·kg-1 ·min-1 starting from 5 min before aortic unclamping.In group C,the equal volume of normal saline was infused instead of ulinastatin.Myocardial specimens were taken from the right auricle at 45 min after aortic unclamping for determination of Fas,Fas ligand (FasL),caspase-8,Bcl-2 and Bax expression and cell apoptosis.The ratio of Bcl-2 expression to/Bax expression (Bcl-2/Bax) and apoptotic index were calculated.Results Fas,FasL,caspase-8 and Bax expression and apoptotic index were significantly lower,and Bcl-2 expression and Bcl-2/Bax were higher in group U than in group C.Conclusion Ulinastatin postconditioning attenuates apoptosis in the myocardial cells through inhibiting Fas/FasL signaling pathway in the patients undergoing cardiac valve replacement with CPB.