七氟烷预处理对心脏瓣膜置换术患者炎性反应及心肌组织GSK3β、STAT5A表达的影响  

Effects of sevoflurane preconditioning on inflammatory response and myocardial expression of GSK-3β and STAT5A in the patients undergoing valve replacement

作　　者：陈勤[1] 余丹[1] 游嘉[1] 李洪[1] 杜智勇[1] 黄河[1] 杨天德[1] 

机构地区：[1]第三军医大学新桥医院麻醉科,重庆400037

出　　处：《第三军医大学学报》2016年第7期747-752,共6页Journal of Third Military Medical University

基　　金：第三军医大学新桥医院临床科研基金(2014YLC29)~~

摘　　要：目的探讨七氟烷预处理对体外循环（cardiopulmonary bypass,CPB）下心脏瓣膜置换术患者心肌损伤的影响及潜在机制。方法我院择期行心脏瓣膜置换术患者24例,完全随机分为2组（n=12）：七氟烷预处理组和静脉麻醉对照组。麻醉维持：七氟烷预处理组于麻醉诱导插管后开始吸入1MAC七氟烷20 min,再洗脱10 min;静脉麻醉对照组术中不吸入七氟烷。于麻醉诱导后即刻（T0）、主动脉开放2 h（T1）、6 h（T2）、24 h（T3）、48 h（T4）采集桡动脉血并分离血浆,采用ELISA测定TNF-α、IL-6浓度,双向测流免疫法测定心肌肌钙蛋白Ⅰ（cardiac troponinⅠ,c TnⅠ）浓度及免疫抑制法测定磷酸肌酸同工酶（creatine phosphokinase isoenzyme,CK-MB）活性;于七氟烷洗脱后CPB前取右心耳组织,用Western blot检测糖原合成酶激酶3β（glycogen synthase kinase 3β,GSK3β）、STAT5A磷酸化水平表达。结果与T0比较,2组T1～T3时的c TnⅠ、TNF-α、IL-6浓度及CK-MB活性均升高（P〈0.05）;与对照组比较,预处理组T1～T2时的TNF-α、T1～T3时的IL-6的浓度均降低（P〈0.05）,而c TnⅠ浓度、CK-MB活性2组差异无统计学意义（P〉0.05）;与对照组比较,预处理组患者的右心耳组织的GSK3β、STAT5A磷酸化水平明显增高（P=0.046 9、0.005 8）。结论七氟烷预处理减轻心脏瓣膜置换术患者的炎症反应并且可能通过增加心肌组织GSK3β、STAT5A磷酸化表达介导心肌保护效应。Objective To determine the effects of sevoflurane preconditioning on inflammatory response and myocardial injury in the patients undergoing valve replacement under cardiopulmonary bypassing（ CPB） and investigate its underlying mechanisms. Methods Twenty-four patients scheduled for elective valve replacement in our hospital from May to August 2015 were recruited in this study,and they were randomly divided into 2 groups（ n = 12）,sevoflurane preconditioning group and total intravenous anaesthesia group（ control）. Sevoflurane of 1 minimum alveolar concentration（ MAC） was administered for 20 min after intubation followed by a 10 min washout before CPB in sevoflurane preconditioning group, and such administration for the intravenous anesthesia control group. Blood samples were collected for detection of plasma concentrations of TNF-α and IL-6 by ELISA,that of c TnⅠby bidirectional lateral flow immunoassay,and activity of creatine-MB by immunosuppressiom assay after anesthesia induction（ T0）,at 2（ T1）,6（ T2）,24（ T3） and 48 h（ T4） after aorta de-clamping respectively. A biopsy of the atrium was taken between the end of washout period and start of the CPB to determine the expression of phosphorylated GSK3βand STAT5 A by Western blotting. Results The plasma concentration of c Tn Ⅰ,TNF-α,IL-6 and the activity of creatine-MB at T1 ~ T3 were significantly increased in both groups when compared with T0（ P 〈0. 05）. Compared with control group,the concentrations of TNF-α at T1 ~ T2 and IL-6 at T1 ~ T3 were obviously decreased（ P 〈 0. 05）,while the concentration of c Tn Ⅰ and the activity of CK-MB had no differences. The expression levels of phosphorylated GSK3β and STAT5 A were significantly increased in the preconditioning group than the control group（ P = 0. 0469,P = 0. 0058）. Conclusion Sevoflurane preconditioning reduces the inflammatory reaction in the patients undergoing valve replacement,and exerts cardio-protective effects by enhancing phosphorylation of GSK

关 键 词：麻醉药 吸入 缺血预处理 心肌 再灌注损伤 糖原合成酶激酶3Β STAT5A 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学] R654.2[医药卫生—基础医学]