自体冷血停搏液对未成熟心肌保护作用与磷酸化蛋白激酶的相关性研究  

Research on correlation between the protection effect of cold autologous blood cardioplegia solution to immature myocardium and the P-AKT

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

机构地区：[1]深圳市儿童医院心血管中心,广东深圳5180026

出　　处：《中国体外循环杂志》2017年第1期5-8,22,共5页Chinese Journal of Extracorporeal Circulation

基　　金：深圳市科技计划项目(201303069)

摘　　要：目的探讨自体冷血停搏液对未成熟心肌保护作用与磷酸化蛋白激酶B(P-AKT)抗凋亡机制的相关性。方法82例行体外循环术的先天性心脏病婴儿随机分为:非自体冷血停搏液(A)组33例和自体冷血停搏液(B)组49例。阻断前和主动脉开放30 min取右心耳组织,TUNEL法检测心肌细胞凋亡情况,计算凋亡指数(AI);免疫组织化学法测定心肌组织磷酸化AKT(P-AKT),记录术中复跳时间、复跳率、术后2 h左心室心肌运动指数(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AI均无显著差异(P>0.05);主动脉开放30 min后,两组心肌组织的P-AKT和AI均显著升高(P<0.05),B组P-AKT显著高于A组(P<0.05),B组AI显著底于A组(P<0.05)。两组的复跳时间、术后2 h左心室Tei指数、心脏指数(CI)、LVEF、正性肌力药物依赖情况及术后24 h心律失常发生率等均有显著差异,B组显著优于A组(P<0.05)。心肌组织的P-AKT水平与AI、复跳时间及Tei指数负相关(P<0.05);与LVEF及CI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,对心脏具有更好的保护作用。Objective To explore the correlation between the protection effect of cold autologous blood cardioplegia solution to immature myocardium and the phosphorylated protein kinase B（ P-AKT）. Methods 82 infants with cyanotic congenital heart disease undergoing cardiac surgery were randomly divided into cold non-autologous blood cardioplegic solution（ A） group（ n = 33） and cold autologous blood cardioplegic solution group（ B） group（ n = 49）. The right auricle tissue was taken before the aortic cross-clamping and 30 minute after the aortic cross-clamping to detect myocardial cell apoptosis and calculate the apoptosis index（ AI） with TUNEL method,and to detect the phosphorylated AKT（ P-AKT） with the immunohistochemical method. The auto-beating time and rate during operation,the left ventricular myocardial performance index（ Tei Index）,the cardiac Index（ CI）,left ventricular ejection fraction（ LVEF）,positive inotropic drug administration 2 hs postoperatively,and the incidence rate of cardiac arrhythmia 24 hs postoperatively of all patients were recorded. Results There was no significant difference on the levels of P-AKT and AI before the aortic cross-clamping between 2 groups（ P〈0.05）,while all significantly elevated 30 minutes after the aortic cross-clamping（ P〈0.05）. There were significant differences on the auto-beating time,left ventricular Tei index,CI,LVEF and positive inotropic drug administration 2hs postoperatively,the incidence rate of cardiac arrhythmia 24 hs postoperatively between two groups（ P〈0.05）. The level of P-AKT in myocardial tissue was negatively correlated with AI,auto-beating time and Tei index（ P〈0. 05）,positively correlated with the LVEF and CI（ P〈0.05）. Conclusion Compared with cold non-autologous blood cardioplegic solution,cold autologous blood cardioplegic solution can promote myocardial p-AKT protein expression,reduce myocardial cell apoptosis,and has better protective effects for immature myocardium.

关 键 词：自体冷血停搏液 婴儿 未成熟心肌 先天性心脏病 蛋白激酶B/AKT 

分 类 号：R726.5[医药卫生—儿科]