体外循环对小儿中性粒细胞凋亡及其调控蛋白的影响.docVIP

体外循环对小儿中性粒细胞凋亡及其调控蛋白的影响 作者：赵砚丽,李建立,武懿 作者单位：河北省人民医院,1.麻醉科;2.心外科,河北 石家庄 050051 【摘要】 目的 动态观察患儿在体外循环（extracorporeal circulation,ECC）各时段外周血中性粒细胞（polymorphonuclear neutrophil,PMN）的凋亡率，及其脂肪酸合成酶(Fas)、B细胞淋巴瘤(Bcl-2)蛋白表达的变化规律，为临床从PMN凋亡调控入手防治ECC引发的全身炎性反应（SIRS）提供实验室依据。方法 选择择期ECC下行室间隔缺损修补术的患儿30例，采用流式细胞术检测ECC前（T0），ECC开始后30 min（T1），停ECC后30min（T2），术后24 h（T3）各时点静脉血中PMN的凋亡率、Fas和Bcl-2的表达。结果 与T0比较，PMN凋亡率在T2达最低值（P＜0.05），与ECC持续时间呈负相关（r=-0.648，P＜0.05）；与T0比较，PMN膜上Fas阳性表达百分数在T2时点降低（P＜0.05），与PMN凋亡率呈正相关（r=0.546，P＜0.05）；与T0比较，T1、T2、T3时点PMN胞内Bcl-2阳性表达百分数升高（P＜0.05），与PMN凋亡率呈负相关（r=-0.569，P＜0.05）。结论 小儿ECC触发全身炎性反应的过程中产生的多种凋亡抑制因素使PMN凋亡受到抑制，其机制与PMN的Fas表达下调和Bcl-2表达上调有关。 【关键词】 体外循环；中性粒细胞；细胞凋亡；脂肪酸合成酶;B细胞淋巴瘤 Effects of Extracorporeal Circulation on Polymorphonuclear Neutrophil Apoptosis and Related Protein in Pediatric ZHAO Yan-li，LI Jian-li，WU Yi,LIU Xiao-ming,DU Yan-ru,YAN Zhi-jun (Department of Anesthesiology,HeBei Provincial Peoples Hospital,Hebei ShiJiaZhuang 050051,China) Abstract: OBJECTIVE To investigate the changes in polymorphonuclear neutrophil（PMN） apoptosis and Fas, Bcl-2 protein expression of pediatric patients undergoing open-heart surgery with ECC, and to give the experimental basis for treating systemic inflammatory reaction syndrome(SIRS). METHODS Thirty pediatric patients with ventricular septal defect undergoing open-heart surgery with ECC were studied. Blood samples were taken after induction of anesthesia(T0),30 minutes after the initiation ECC(T1),30 minutes after the termination ECC(T2) and 24 hours post-operatively(T3). PMN apoptosis and the expression of PMN Fas, Bcl-2 protein were detected by flow cytometry. RESULTS Compared with T0, the rate of PMN apoptosis reached to its lowest value at T2(P0.05). The percentage of PMN apoptosis correlated negatively with the duration of ECC (r=-0.648，P0.05). Fas on PMN membrane at T2 was significantly downregulated than T0. Fas levels correlated positively with PMN apoptosis rate