腺苷预处理对非体外循环冠状动脉旁路移植术患者心肌TNF-α mRNA和ICAM-1 mRNA表达的影响  

Effects of adenosine preconditioning on expression of myocardial TNF-α mRNA and ICAM-1 mRNA in patients undergoing off-pump coronary artery bypass graft operation

作　　者：杨静[1] 杨大烜[1] 叶珏[1] 张毅[1] 李立环[1] 

机构地区：[1]中国协和医科大学 中国医学科学院 阜外心血管病研究所 北京阜外心血管病医院麻醉科,100037

出　　处：《中华麻醉学杂志》2008年第4期342-345,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨腺苷预处理对非体外循环冠状动脉旁路移植术（OPCABG）患者心肌肿瘤坏死因子-α（TNF-α）mRNA和细胞间黏附分子-1（ICAM-1）mRNA表达的影响。方法 择期初次行OPCABG患者40例，年龄44～68岁，随机分为2组（n=20）：对照组和腺苷组。腺苷组于冠状动脉吻合前15min经颈内静脉输注腺苷50μg·kg^-1·min^-1，1min后上调至100μg·kg^-1·min^-1，2min后上调至150μg·kg^-1·min^-1，输注7min。输注结束后5min开始冠状动脉吻合，对照组给予生理盐水。连续监测血液动力学参数。于腺苷预处理前（基础状态）和恢复血流15min时，取右心耳组织约0．5g，RT-PCR相对定量法测定心肌TNF—α mRNA和ICAM-1mRNA的表达，透射电镜观察心肌超微结构。结果与对照组比较，腺苷组心肌TNF—αmRNA和ICAM—lmRNA表达下调（P〈0．05），心肌病理损伤减轻。结论腺苷预处理可通过下调OPCABG患者心肌TNF—α和ICAM—1mRNA表达，从而减轻心肌损伤。[Abstract] Objective To investigate the effects of adenosine preconditioning on the expression of myocardial TNF-α mRNA and ICAM-1 mRNA in patients undergoing off-pump coronary artery bypass graft （OPCABG） .Methods Forty patients, aged 44-68 yr, with more than three coronary artery obstructions and ejection fraction≥ 40%, undergoing elective OPCABG, were randomly divided into 2 groups （n = 20 each）： control group and ADO group. ADO group received adenosine preconditioning, the initial infusion rate was 50·μg· kg^-1·min^-1 , then increased to 100 μg·kg^-1·min^-1 after 1 min, increased to 150μg·kg^-1 ·min^-1 after 2 min and maintaining for 7 min. The vascular anastomosis was started at 5 min after preconditioning. While the control group received normal saline.instead of adenosine. Tissue samples of the right auricle were taken before preconditioning （baseline） and at 15 min after blood current return to measure the expression of myocardial TNF-α mRNA and ICAM-1 mRNA and the myocardial ultrastructure was observed. Hemodynamic parameters were monitored. Results The myocardial damage was milder in ADO group than in control group . The expression of myocardial TNF-α mRNA and ICAM-1 mRNA was significantly lower in ADO group than in control group （ P 〈 0.05）. Conclusion Adenosine preconditioning can attenuate myocardium ischemia-reperfusion injury in patients undergoing OPCABG through down-regulating the expression of myocardial TNF-α mRNA and ICAM-1 mRNA.

关 键 词：腺苷 肿瘤坏死因子α 细胞粘附分子 冠状动脉旁路移植术 非体外循环 缺血预处理 

分 类 号：R654.2[医药卫生—外科学] R644[医药卫生—临床医学]