体外循环围术期细胞黏附分子CD11b/CD18,P选择素的表达及其意义  

Expression Change and Its Implication of Cell Adhesion Molecules CD11b/CD18,sP-selectin in Perioperative Period of Cardiopulmonary Bypass

作　　者：贾维坤[1] 张尔永[2] 魏蜀亮[1] 杜丹妮[1] 文红英[1] 邓力[1] 

机构地区：[1]川北医学院附属医院胸心外科,四川南充637000 [2]四川大学华西医院胸心血管外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2010年第4期279-282,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的观察体外循环(CPB)心内直视手术围术期细胞黏附分子CD11b/CD18及可溶性P选择素(sP-selectin)的表达变化,探讨二者在CPB诱发的全身炎症反应(SIRS)中的作用。方法选择我院2008年1～8月在CPB下行风湿性心脏病瓣膜置换手术患者30例纳入研究,其中男18例,女12例;年龄29～55岁(45.3±8.1岁);分别于麻醉诱导后切开皮肤前(CPB前)、CPB后30min、1h、6h、12h和24h6个时点取桡动脉血,采用流式细胞技术检测外周血中性粒细胞CD11b/CD18分子的表达变化;酶联免疫吸附法测定血浆中内皮细胞sP-selectin的浓度。结果 30例患者外周血中性粒细胞CD11b/CD18于CPB后30min即开始升高,且在CPB后6h达峰值(581.44±215.26),与CPB前比较差异有统计学意义(P<0.05);于CPB后12h开始下降,但仍高于CPB前水平,至CPB后24h时其表达低于CPB前水平,差异无统计学意义(P>0.05);外周血sP-selectin的表达于CPB后30min明显升高并达峰值(51.44±10.06ng/ml),与CPB前比较差异有统计学意义(P<0.05),自CPB后12h开始其活性表达下降,并低于CPB前水平,但差异无统计学意义(P>0.05)。结论 CPB可促发外周血中性粒细胞CD11b/CD18及内皮细胞sP-selectin分子表达水平增高,在CPB导致的全身炎症反应中可能发挥重要作用。Objective To observe the significance of the changes of cell adhesion molecules （CAM） CD11b/CD18 and sP-selectin during the perioperative period of open heart surgery under cardiopulmonary bypass （CPB）,and investigate the roles of CD11b/CD18 and sP-selectin in systemic inflammatory response triggered by CPB.Methods Thirty patients including 18 males and 12 females,age ranged from 29 to 55 years （45.3±8.1 years） having undergone valvular replacement for rheumatic heart disease in our hospital were selected as the subjects of this research.After anesthesia induction,radial arterial blood sample was collected at six different time points including the time prior to skin incision,and 30 min,1 h,6 h,12 h and 24 h following the start of CPB.The expression levels of CD11b/CD18 were tested by flow cytometry,and concentration of sP-selectin in the plasma was measured with enzyme-linked immunosorbent assay（ELISA）.Results The expression of CD11b/CD18 was elevated at 30min after CPB,and it reached the peak （581.44±215.26） at 6 h after CPB with significant differences （P〈0.05）.Its expression started to drop at 12 h after CPB,but it was still higher than the expression level before CPB.The expression returned under the level before CPB at 24 h after CPB with insignificance differences （P〉0.05）.The expression of sP-selectin in the peripheral blood started to rise evidently at 30 min after CPB,reaching the peak （51.44±10.06 ng/ml） with significant differences （P〈0.05）.Its expression level decreased at 12 h after CPB and fell back below the level before CPB with insignificant differences （P〉0.05）.Conclusion CPB can cause the expression of CD11b/CD18 and sP-selectin to rise in the peripheral blood,which may play an important role in the systemic inflammatory response triggered by CPB.

关 键 词：体外循环 心脏直视手术 细胞黏附分子 CD11B/CD18 可溶性P选择素 

分 类 号：R654.1[医药卫生—外科学]