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  

Role of Fas/FasL signaling pathway in ulinastatin postconditioning-induced attenuation of apoptosis in myocardial cells of patients undergoing cardiac valve replacement with cardiopulmonary bypass

作　　者：王焰斌[1] 崔刚[2] 王小雷[1] 陈伟新[3] 程毅坚[1] 翟宇佳[1] 杨建安[3] 

机构地区：[1]广东省深圳市孙逸仙心血管医院麻醉科,518020 [2] 西安交通大学医学部病理系 [3] 广东省深圳市孙逸仙心血管医院心脏外科

出　　处：《中华麻醉学杂志》2014年第8期940-943,共4页Chinese Journal of Anesthesiology

基　　金：2010年天普研究基金01200903）后续滚动资助项目（2012年）

摘　　要：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.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.

关 键 词：抗原 CD95 Fas配体蛋白质 胰蛋白酶抑制剂 细胞凋亡 心肺转流术 心脏瓣膜假体植入 后处理 

分 类 号：R614[医药卫生—麻醉学]