心脏不停跳法对二尖瓣置换术患者心肌损伤时内质网应激及细胞凋亡的影响  

Effects of beating heart on endoplasmic reticulum stress and myocardial apoptosis in patients with mitral valve replacement

作　　者：张春雷 张加强 林洪启 王艳红 Zhang Chunlei;Zhang Jiaqiang;Lin Itongqi;Wang Yanhong(Department of Anesthesiology, People＇s Hospital of Zhengzhou University, Zhengzhou 450003, Chin)

机构地区：[1]郑州大学人民医院麻醉科,450003

出　　处：《中华胸心血管外科杂志》2018年第4期210-215,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评价心脏不停跳法对二尖瓣置换术（MVR）患者心肌损伤时内质网应激（ERS）及细胞凋亡的影响。方法选取风湿性心脏病伴有二尖瓣狭窄并择期行MVR的患者80例，性别不限，年龄38-59岁，体质量43-73kg，美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级，采用随机数字表法分为心脏不停跳组（BH组）40例和心脏停跳组（CA组）40例。分别于切开右心房即刻（阳）、主动脉阻断后30min[BH组为体外循环（CPB）开始后30min，T1]和缝合右心房（y2）时抽取桡动脉血，采用酶联免疫吸附法（ELISA）检测血浆肌酸激酶同工酶（CK-MB）和心肌肌钙蛋白T（cTnT）的浓度。分别于110～他时采集右心耳组织，采用逆转录一聚合酶链式反应（RT—PCR）和Westernblot法分别检测葡萄糖调节蛋白78（GRP78）、C／EBP同源蛋白（CHOP）和c-Jun氨基末端激酶（JNK）mRNA及GRP78、CHOP和磷酸化JNK（p-JNK）蛋白表达。采用原位细胞凋亡检测法（TUNEL法）检测心肌细胞凋亡情况。结果与CA组比较，BH组T1-T2时血浆CK-MB、cTnT浓度及T2时心肌细胞凋亡率均降低（P〈0．05）。BH组T1～T2时心肌GRP78、CHOP和JNKmRNA表达均低于CA组（P〈0．05），且BH组T1～1、2时心肌GRP78、CHOP和p-JNK蛋白表达亦均低于CA组（P〈0．05）。结论心脏不停跳法可减轻ERS，减少心肌细胞凋亡，从而减轻MVR患者心肌损伤。Objective To explore the effects of beating heart on endoplasmic reticulum stress（ERS） and myocardial ap- optosis in patients with mitral valve replacement（ MVR）. Methods A total, of 80 patients with rheumatic heart disease and mitral valve stenosis, all genders, aged 38 to 59 years old, weighed 43 to 73 kg, with American Society of Anesthesiologists （ASA） physical status classification Ⅱ-Ⅲ and scheduled for MVR, were randomly divided into beating heart group （ BH group, n=40） and cardiac arrest group （CA group, n = 40）. Radial artery blood was collected to determine the concentration of plasma creatine kinase-MB （CK-MB） and cardiac troponin T（cTnT） by enzyme-linked immunosorbent assay（ELISA） at the start of opening the right atrium（ T0）, 30 minutes after aortic cross-clamping[ 30 minutes after cardiopulmonary bypass（CPB） in BFI group, T1] and when stitched right atrium（T2）, respectively. Right auricle tissue was collected at T0 and T2, respectively, and the mRNA expression of glucose regulated protein 78 （ GRP78 ）, CCAAT/enhancer-binding protein homologous pro-tein（CHOP） and c-Jun amino-terminal kinase（JNK） or the protein expression of GRP78, CHOP and p-JNK in cardiac muscle tissue were detected by reverse transcription-polymerase chain reaction（RT-PCR） or Western blot, respectively. The apoptosis of cardiomyocytes was determined by terminal deoxynucleotidy transferase-mediated dUTP nick-end labeling（TUNEL） method. Results Compared with CA group at the same time point, the concentrations of plasma CK-MB and cTnT at T1 and T2 and the rate of myocardial cell apoptosis at T2 were all lower（ P 〈 0.05 ） in BH group. The mRNA expression of GRP78, CHOP and JNK in cardiac muscle tissue in BH group were all lower（ P 〈 0.05 ） than those in CA group at T1 and T2, and the protein expression of GRP78, CHOP and p-JNK in cardiac muscle tissue in BH group were all lower（P 〈0.05） than those in CA group at T1 and T2. Conclusion Beating heart sur

关 键 词：心肺转流术 心脏瓣膜 人工 内质网 应激 细胞凋亡 

分 类 号：R654.2[医药卫生—外科学]