鹽酸戊乙奎醚對體外循環(huán)中TLR4表達的影響
發(fā)布時間：2018-08-21 08:54
【摘要】：目的：心臟手術(shù)中體外循環(huán)總是伴隨著炎癥反應(yīng),增加了術(shù)后的并發(fā)癥。我們使用鹽酸戊乙奎醚進行干預(yù),觀察其在體外循環(huán)(Cardiopulmonary bypass, CPB)中對Toll樣受體4(Toll-like receptor4, TLR4)表達的影響,并探討TLR4與炎癥因子表達的相關(guān)性,為CPB炎癥反應(yīng)的干預(yù)研究提供依據(jù)和思路。 方法：經(jīng)過倫理批準(zhǔn)和簽寫知情同意書后,選取擇期CPB下行心臟瓣膜置換手術(shù)患者40例,隨機分為鹽酸戊乙奎醚組(P組)和生理鹽水組(C組),P組患者在體外循環(huán)開始前靜脈給予0.1g/kg的鹽酸戊乙奎醚注射液,C組在同一時點給予等量生理鹽水。分別在麻醉前(T0)、主動脈阻斷5min(T1)、CPB結(jié)束(T2)、術(shù)后1天(T3)抽取動脈血,酶聯(lián)免疫吸附劑測定法(ELISA)測定血漿白介素(interleukin) IL-6、IL-8、IL-10、腫瘤壞死因子-α (Tumor Necrosis Factor-α, TNF-α)的濃度,流式細胞術(shù)檢測單核細胞表面TLR4表達,并觀察術(shù)后肺炎發(fā)生率、呼吸機帶機時間、ICU停留時間、術(shù)后有無譫妄等指標(biāo)。 結(jié)果：CPB能顯著上調(diào)IL-6、IL-8、TNF-α、IL-10細胞因子的表達。IL-6、IL-8在主動脈阻斷5min (T1)、CPB結(jié)束即刻(T2)、術(shù)后1天(T3)三個時點濃度都較麻醉前(T0)明顯升高(P0.05),且同一時點鹽酸戊乙奎醚組(P組)較生理鹽水組(C組)低表達(P0.05)。TNF-α在手術(shù)開始后持續(xù)增加,在術(shù)后1天(T3)達峰值,P組TNF-α的濃度在CPB結(jié)束即刻(T2)、術(shù)后1天(T3)時點較C組明顯減低。IL-10在兩組均于主動脈阻斷5min (T1)開始上升, CPB結(jié)束即刻(T2)達峰值,P組明顯高表達于C組(P0.05),隨后下調(diào),C組在術(shù)后1天(T3)下調(diào)至術(shù)前水平,P組在術(shù)后1天(T3)時仍高于術(shù)前水平(P0.05)。TLR4的表達從主動脈阻斷5min(T1)起開始升高,CPB結(jié)束即刻(T2)達到峰值,隨后下調(diào)。P組在T1、T2時點較C組低表達(P0.05)。術(shù)后肺炎發(fā)生率、呼吸機帶機時間、ICU停留時間、術(shù)后有無譫妄等指標(biāo),兩組差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：體外循環(huán)中TLR4與炎癥因子表達相一致,應(yīng)用鹽酸戊乙奎醚干預(yù)能下調(diào)TLR4的表達,起到減輕炎癥反應(yīng)的作用。
[Abstract]:Objective: cardiopulmonary bypass (CPB) is always accompanied by inflammatory reaction in cardiac surgery, which increases postoperative complications. In order to investigate the effect of penehyclidine hydrochloride on the expression of Toll-like receptor 4 (TLR4) in (Cardiopulmonary bypass, CPB) under cardiopulmonary bypass (CPB), and to explore the correlation between TLR4 and inflammatory factor expression, we provide evidence and ideas for the intervention of CPB inflammatory response. Methods: after ethical approval and informed consent, 40 patients undergoing elective CPB cardiac valve replacement were selected. They were randomly divided into two groups: group P (group P) and group P (group C). Patients in group P were given 0.1g/kg via intravenous vein before CPB. Group C was given the same amount of normal saline at the same time point before the beginning of cardiopulmonary bypass (CPB). Before anesthesia (T0), aortic occlusion of 5min (T1) ended with CPB (T2), and arterial blood was taken 1 day after operation (T3). The concentrations of IL-8 IL-10, TNF- 偽 (Tumor Necrosis factor- 偽 and interleukin-6 (IL-6) IL-8 IL-10, TNF- 偽 in plasma were measured by (ELISA) assay with enzyme linked immunosorbent assay (Elisa). Flow cytometry was used to detect the expression of TLR4 on the surface of monocytes. The incidence of pneumonia, the duration of ventilator and the time of stay in ICU, and the postoperative delirium were observed. Results 1: CPB could significantly up-regulate the expression of IL-10 cytokines. IL-6 IL-8 was significantly increased at the end of 5min (T1) after aortic occlusion (T2). The concentrations at all three points 1 day after CPB (T3) were significantly higher than those before anesthesia (P0.05), and at the same time point, pentaniline hydrochloride (P group) was significantly higher than that of raw rats (P group). The low expression of TNF- 偽 in saline group (P 0.05) continued to increase after operation. At the end of CPB (T2), the concentration of TNF- 偽 in group P was significantly lower than that in group C on day 1 (T3) after operation. IL-10 was increased in both groups at the beginning of aortic occlusion 5min (T1), and the expression of TNF- 偽 in group P was significantly higher at the end of CPB (T2) than that in group C (TNF- 偽) at the end of CPB. In group C (P0.05), the expression of TLR4 in group C was still higher than that in group C (P0.05), and then decreased to the level of preoperative level 1 day after operation (T3). The expression of TLR4 increased from the beginning of aortic occlusion (T1) to the peak at the end of 5min (T2) in group P (P < 0.05), and the expression of TLR4 in group P was significantly higher than that in group P (P < 0.05). Then down-regulated. P group at T 1 T 2 was lower than C group (P 0.05). There was no significant difference between the two groups in the incidence of pneumonia, the duration of ventilator and the time of stay in ICU, the postoperative delirium or not (P0.05). Conclusion: the expression of TLR4 is consistent with the expression of inflammatory factors during cardiopulmonary bypass (CPB). The intervention of penehyclidine hydrochloride can down-regulate the expression of TLR4 and alleviate the inflammatory reaction.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614
本文編號：2195202
[Abstract]:Objective: cardiopulmonary bypass (CPB) is always accompanied by inflammatory reaction in cardiac surgery, which increases postoperative complications. In order to investigate the effect of penehyclidine hydrochloride on the expression of Toll-like receptor 4 (TLR4) in (Cardiopulmonary bypass, CPB) under cardiopulmonary bypass (CPB), and to explore the correlation between TLR4 and inflammatory factor expression, we provide evidence and ideas for the intervention of CPB inflammatory response. Methods: after ethical approval and informed consent, 40 patients undergoing elective CPB cardiac valve replacement were selected. They were randomly divided into two groups: group P (group P) and group P (group C). Patients in group P were given 0.1g/kg via intravenous vein before CPB. Group C was given the same amount of normal saline at the same time point before the beginning of cardiopulmonary bypass (CPB). Before anesthesia (T0), aortic occlusion of 5min (T1) ended with CPB (T2), and arterial blood was taken 1 day after operation (T3). The concentrations of IL-8 IL-10, TNF- 偽 (Tumor Necrosis factor- 偽 and interleukin-6 (IL-6) IL-8 IL-10, TNF- 偽 in plasma were measured by (ELISA) assay with enzyme linked immunosorbent assay (Elisa). Flow cytometry was used to detect the expression of TLR4 on the surface of monocytes. The incidence of pneumonia, the duration of ventilator and the time of stay in ICU, and the postoperative delirium were observed. Results 1: CPB could significantly up-regulate the expression of IL-10 cytokines. IL-6 IL-8 was significantly increased at the end of 5min (T1) after aortic occlusion (T2). The concentrations at all three points 1 day after CPB (T3) were significantly higher than those before anesthesia (P0.05), and at the same time point, pentaniline hydrochloride (P group) was significantly higher than that of raw rats (P group). The low expression of TNF- 偽 in saline group (P 0.05) continued to increase after operation. At the end of CPB (T2), the concentration of TNF- 偽 in group P was significantly lower than that in group C on day 1 (T3) after operation. IL-10 was increased in both groups at the beginning of aortic occlusion 5min (T1), and the expression of TNF- 偽 in group P was significantly higher at the end of CPB (T2) than that in group C (TNF- 偽) at the end of CPB. In group C (P0.05), the expression of TLR4 in group C was still higher than that in group C (P0.05), and then decreased to the level of preoperative level 1 day after operation (T3). The expression of TLR4 increased from the beginning of aortic occlusion (T1) to the peak at the end of 5min (T2) in group P (P < 0.05), and the expression of TLR4 in group P was significantly higher than that in group P (P < 0.05). Then down-regulated. P group at T 1 T 2 was lower than C group (P 0.05). There was no significant difference between the two groups in the incidence of pneumonia, the duration of ventilator and the time of stay in ICU, the postoperative delirium or not (P0.05). Conclusion: the expression of TLR4 is consistent with the expression of inflammatory factors during cardiopulmonary bypass (CPB). The intervention of penehyclidine hydrochloride can down-regulate the expression of TLR4 and alleviate the inflammatory reaction.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614
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