乌司他丁在婴幼儿体外循环时的抗炎和肺功能的保护作用

摘要

Objective: To explore the effect of ulinastatin on anti-inflammation and pulmonary function protection with its mechanism for infants at cardiopulmonary bypass surgery. Methods: A total of 38 infants with ventricular septal defect undergoing cardiac operation were randomly divided into 2 groups. Ulinastatin group, the patients received uliastatin 20 000 U/kg,n=20 and Control group, the patients received the same volume of normal saline,n=18. The serum levels of TNF-α, IL-2, IL-l0 were examined at 4 time points: 5 min before skin incision (T1), immediate opening of aorta (T2), 4 hours after operation (T3) and 24 hours after operation (T4). The expressions of CD4+CD45+ T cells and CD4+Foxp3+ T cells were measured at T4. The respiratory index and oxygenation index at 4 time points were compared between 2 groups. Results: Compared with Control group, Ulinastatin group had the lower levels of TNF-α, IL-2 and higher level of IL-l0 at T2, T3, T4; Ulinastatin group also had the higher oxygenation index and lower respiratory index at T2, T3, T4, allP<0.05. Ulinastatin group had less expression of CD4+CD45+ T cells (35.98 ± 3.67)% than Control group (41.94 ± 4.56)% , and more expression of CD4+Foxp3+ T cells (19.65 ± 3.45)% than Control group (6.45 ± 1.47)%,P<0.05-P<0.01. Conclusion: Ulinastatin may improve the differentiation from CD4+CD45+ T cell to Foxp3+CD4+ T cell, down regulating inlfammatory response and protecting pulmonary function for infants at cardiopulmonary bypass surgery.%目的：探讨乌司他丁对婴幼儿体外循环时的抗炎和肺功能保护作用及其机制。方法：选取婴幼儿心内直视手术的室间隔缺损患儿38例，随机分为两组，给予20000 U/kg剂量的乌司他丁者为乌司他丁组（n=20）和给予等量生理盐水者为对照组（n=18）。观察患儿的临床相关指标，检测切皮前5min（T1）、主动脉开放时（T2）、术后4 h（T3）和术后24 h（T4）四个时间点血清肿瘤坏死因子α（TNF-α）、白细胞介素-2（IL-2）和白细胞介素-10（IL-10）水平，术后24 h患儿的CD4+CD45+ T细胞水平和调节性T细胞（CD4+Foxp3+ T）水平，并对患儿的四个时间点的呼吸指数和氧合指数四个时间点进行比较。结果：乌司他丁组在T2、T3和T4三个时间点的TNF-α、IL-2水平明显低于对照组，IL-10水平明显高于对照组；乌司他丁组在T2、T3和T4三个时间点的氧合指数明显高于对照组，呼吸指数明显低于对照组；乌司他丁组的患儿的CD4+CD45+ T细胞所占淋巴细胞的百分比[（35.98±3.67）%]较对照组[（41.94±4.56）%]降低，调节性T细胞（CD4+Foxp3+ T）所占淋巴细胞的百分[（19.65±3.45）%]较对照组[（6.45±1.47）%]升高。上述比较差异均有统计学意义（P<0.05~P<0.01）。结论：婴幼儿体外循环时应用乌司他丁会促进CD4+CD45+ T细胞向调节性T细胞（CD4+Foxp3+ T）的分化，从而下调机体的炎症水平，对患儿的肺功能起保护性作用。