PI3K/Akt 通路介导的凋亡机制在自体冷血停搏液对未成熟心肌中的保护作用  

Protective effects of cold autologous blood cardioplegic solution on immature myocardium by suppressing apoptosis via P13K/Akt signal pathway

作　　者：马超[1] 丁以群[1] 张青[1] 沈定荣[1] 孟祥春[1] 王元祥[1] 彭乐[1] 提运幸[1] 孟保英[1] 

机构地区：[1]中国医科大学深圳儿童医院心血管中心,广东深圳518026

出　　处：《中国实用医刊》2017年第4期1-5,F0004,共6页Chinese Journal of Practical Medicine

基　　金：深圳市科技计划项目（201303069）

摘　　要：目的：探讨磷脂酰肌醇-3激酶/丝氨酸/苏氨酸蛋白激酶（PI3K/ Akt）通路介导的凋亡机制在自体冷血停搏液对未成熟心肌中的保护作用。方法将82例行体外循环术的先天性心脏病婴儿，随机分为两组，非自体冷血停搏液（A 组）33例，自体冷血停搏液（B 组）49例，阻断前和主动脉开放30 min 取右心耳组织，免疫组织化学法测定心肌组织磷酸化 Akt（P-Akt）和 Bcl-2、Bax 蛋白的含量，计算 Bax/ Bcl-2比值，记录术后2 h 左心室 Tei 指数、心脏指数（CI）、左心室射血分数（LVEF）和正性肌力药物依赖情况、术后24 h 心律失常发生率等。结果主动脉阻断前心肌组织 P-Akt 和 Bcl-2、Bax 蛋白的含量及 Bax/ Bcl-2比值比较差异均未见统计学意义（P ﹥0.05）；主动脉开放30 min后，两组心肌组织的 p-Akt 和 Bcl-2、Bax 蛋白及 Bax/ Bcl-2均显著升高（P ﹤0.05），B 组 Bcl-2显著高于A 组（P ﹤0.05），B 组 Bax 及 Bax/ Bcl-2比值显著低于 A 组（P ﹤0.05）。两组术后2 h 左心室 Tei 指数、CI、LVEF、正性肌力药物依赖情况及术后24 h 心律失常发生率等比较差异均有统计学意义，且 B 组显著优于 A 组（P ﹤0.05）。心肌组织的 P-Akt 蛋白水平与 Bax/ Bcl-2比值及 Tei 指数呈负相关（P ﹤0.05），与 LVEF 及 CI 呈正相关（P ﹤0.05）。结论对于未成熟心肌，自体冷血停搏液比非自体冷血停搏液能促进心肌 p-Akt 组织蛋白的表达，减轻心肌细胞凋亡，对心脏具有较好的保护作用。Objective To investigate the protective effects of cold autologous blood cardioplegic solution on immature myocardium by suppressing apoptosis via P13K/ Akt signal pathway. Methods Eighty-two infants with cyanotic congenital heart disease underwent cardiac surgery were randomly divided into cold non-autologous blood cardioplegic solution group（ group A,33 cases）and cold autologous blood cardioplegic solution group（group B,49 cases）,took heart right ear organization before the aortic cross-clamping and 30 minute after the aortic cross-clamping,phosphorylated Akt （P-Akt）and the Bcl-2,Bax protein in myocardial tissue was detected by the immunohistochemistry method,and the Bax / Bcl-2 ratio was calculated. The clinic parameters including the left ventricular Tei index,the cardiac index（CI）,LVEF and positive inotropic drug dependence after two hours of cardiac operation,rate of cardiac arrhythmia after 24 hours of cardiac operation. Results The levels of P-Akt, Bcl-2,Bax protein and the Bax / Bcl-2 ratio before the aortic cross-clamping had no significant different （P ﹥ 0. 05）,the levels of P-Akt,Bcl-2,Bax protein and the Bax / Bcl-2 ratio were elevated significantly （P ﹤ 0. 05）in the two groups 30 minute after the aortic cross-clamping. Bcl-2 protein levels in group B＆amp;nbsp;was higher than that in group A（P ﹤ 0. 05）,Bax protein and the Bax / Bcl-2 ratio in group B were lower than those in group A（P ﹤ 0. 05）. The left ventricular Tei index,CI,LVEF and positive inotropic drug dependence after two hours of cardiac operation,rate of cardiac arrhythmia after 24 hours of cardiac operation in the two groups had significant differences（P ﹤ 0. 05）,and group B was significantly better than that of group A（P ﹤ 0. 05）. There were negative correlation of P-Akt in myocardial tissue with the Bax / Bcl-2 ratio,left ventricular Tei index（P ﹤ 0. 05）,P-Akt in myocardial tissue had positive correlation with the LVEF and CI（P ﹤ 0. 05）. Conclusions Compared with cold non

关 键 词：自体冷血停搏液 婴儿 未成熟心肌 磷脂酰肌醇-3 激酶/ 丝氨酸/ 苏氨酸蛋白激酶通路 

分 类 号：R726.5[医药卫生—儿科]