盐酸戊乙奎醚对体外循环中TLR4表达的影响
发布时间：2018-08-21 08:54
【摘要】：目的：心脏手术中体外循环总是伴随着炎症反应,增加了术后的并发症。我们使用盐酸戊乙奎醚进行干预,观察其在体外循环(Cardiopulmonary bypass, CPB)中对Toll样受体4(Toll-like receptor4, TLR4)表达的影响,并探讨TLR4与炎症因子表达的相关性,为CPB炎症反应的干预研究提供依据和思路。 方法：经过伦理批准和签写知情同意书后,选取择期CPB下行心脏瓣膜置换手术患者40例,随机分为盐酸戊乙奎醚组(P组)和生理盐水组(C组),P组患者在体外循环开始前静脉给予0.1g/kg的盐酸戊乙奎醚注射液,C组在同一时点给予等量生理盐水。分别在麻醉前(T0)、主动脉阻断5min(T1)、CPB结束(T2)、术后1天(T3)抽取动脉血,酶联免疫吸附剂测定法(ELISA)测定血浆白介素(interleukin) IL-6、IL-8、IL-10、肿瘤坏死因子-α (Tumor Necrosis Factor-α, TNF-α)的浓度,流式细胞术检测单核细胞表面TLR4表达,并观察术后肺炎发生率、呼吸机带机时间、ICU停留时间、术后有无谵妄等指标。 结果：CPB能显著上调IL-6、IL-8、TNF-α、IL-10细胞因子的表达。IL-6、IL-8在主动脉阻断5min (T1)、CPB结束即刻(T2)、术后1天(T3)三个时点浓度都较麻醉前(T0)明显升高(P0.05),且同一时点盐酸戊乙奎醚组(P组)较生理盐水组(C组)低表达(P0.05)。TNF-α在手术开始后持续增加,在术后1天(T3)达峰值,P组TNF-α的浓度在CPB结束即刻(T2)、术后1天(T3)时点较C组明显减低。IL-10在两组均于主动脉阻断5min (T1)开始上升, CPB结束即刻(T2)达峰值,P组明显高表达于C组(P0.05),随后下调,C组在术后1天(T3)下调至术前水平,P组在术后1天(T3)时仍高于术前水平(P0.05)。TLR4的表达从主动脉阻断5min(T1)起开始升高,CPB结束即刻(T2)达到峰值,随后下调。P组在T1、T2时点较C组低表达(P0.05)。术后肺炎发生率、呼吸机带机时间、ICU停留时间、术后有无谵妄等指标,两组差异无统计学意义(P0.05)。 结论：体外循环中TLR4与炎症因子表达相一致,应用盐酸戊乙奎醚干预能下调TLR4的表达,起到减轻炎症反应的作用。
[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- 伪 (Tumor Necrosis factor- 伪 and interleukin-6 (IL-6) IL-8 IL-10, TNF- 伪 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- 伪 in saline group (P 0.05) continued to increase after operation. At the end of CPB (T2), the concentration of TNF- 伪 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- 伪 in group P was significantly higher at the end of CPB (T2) than that in group C (TNF- 伪) 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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：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- 伪 (Tumor Necrosis factor- 伪 and interleukin-6 (IL-6) IL-8 IL-10, TNF- 伪 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- 伪 in saline group (P 0.05) continued to increase after operation. At the end of CPB (T2), the concentration of TNF- 伪 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- 伪 in group P was significantly higher at the end of CPB (T2) than that in group C (TNF- 伪) 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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
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