体外循环心内直视手术对患者心肌内质网应激的影响  

Effect of open-heart operation involving cardiopulmonary bypass on myocardial endoplasmic reticulum stress

作　　者：谢晓勇[1] 郑宝石[1] 何巍[1] 罗程[1] 黎玉贵 冯旭[1] 

机构地区：[1]广西医科大学第一附属医院心胸外科,南宁530021

出　　处：《中华实验外科杂志》2017年第3期494-496,共3页Chinese Journal of Experimental Surgery

基　　金：广西自治区自然科学基金,广西壮族自治区卫生厅课题（Z2012108）

摘　　要：目的 探讨心内直视手术对内质网应激（ERS）的影响以及不停跳心脏手术能否减轻ERS诱导的心肌炎性反应,具有更好的心肌保护效果.方法 择期行二尖瓣置换术（MVR）的风湿性心脏病40例患者,随机分为心脏不停跳组（不停跳组）和心脏停跳组（停跳组）两组,分别于体外循环（CPB）开始和CPB结束时取两组病例右心耳组织标本,检测标本葡萄糖调节蛋白78（GRP78）、核因子-κB（NF-κB）p65 mRNA表达及蛋白相对含量.结果 两组组病例在CPB开始时GRP78、NF-κBp65 mRNA表达及蛋白相对量比较,差异无统计学意义（P=0.223,0.383;P=0.760、0.736）;CPB结束时,对照组GRP78 mRNA及蛋白表达分别为2.31±0.44、0.096±0.024,实验组为1.56±0.29、0.061±0.021,对照组NF-κBp65 mRNA及蛋白表达分别为2.89±0.93、0.129±0.034,实验组为1.73±0.48、0.085±0.025,和CPB开始比较,两组GRP78、NF-κBp65 mRNA表达及蛋白量均明显升高（P=0.000,0.001;P=0.000,0.003;P=0.000,0.000;P=0.000,0.001）,但不停跳组升高幅度较小（P=0.001,0.002;P=0.001,0.001）.结论 心内直视手术能激活ERS,诱发心肌局部炎性反应;不停跳心脏手术能减轻ERS,减轻心肌的炎性反应.Objective To explore the myocardial endoplasmic reticulum stress （ERS） during the open heart surgery involving cardiopulmonary bypass （CPB）, and whether the reduced ERS by beating-heart technique played an important role in the myocardial protection.Methods Forty patients with rheumatic heart disease undergoing MVR were randomly divided into 2 groups.The patients in the experimental group received operation on beating-heart, while under arrested heart in the control group.Right atrial myocardial samples were taken before and after CPB.The expressions levels of mRNA and protein of GRP78 and NF-κBp65 were detected using real-time PCR and Western blotting.Results After CPB, the expression levels of mRNA and protein of GRP78 were 2.31±0.44 and 0.096±0.024, those of NF-κBp65 were 2.89±0.93 and 0.129±0.034 respectively in the control group.In the experimental group, the expression levels of mRNA and protein of GRP78 were 1.56±0.29 and 0.061±0.021, and those of NF-κBp65 were 1.73±0.48 and 0.085±0.025.As compared with the baseline values, mRNA and protein levels of GRP78 and NF-κBp65 were increased after CPB.The increasing degrees of GRP78 and NF-κBp65 were significantly lower in the experimental group than in the control group （P=0.001, 0.002;P=0.001, 0.001）.Conclusion ERS could be provocated during open-heart operation.The attenuated ERS, through NF-kappaB pathway, may play an important role in myocardial protection by on-pump beating-heart technique.

关 键 词：体外循环心内直视手术 不停跳心脏手术 内质网应激 炎性反应 

分 类 号：R654.2[医药卫生—外科学]