| Objective To investigate the effect of ulinastatin(UTI) on cytokines balance and myocardial cell apoptosis in open heart surgery with cardiopulmonary bypass(CPB). Furthermore, to evaluate the protective effect of ulinastatin on myocardial injury during open heart surgery. Methods Twenty ASA Ⅱ～Ⅲpatients scheduled for elective mitral valve replacement undergo CPB were randomly divided into two groups of 10 each: control group(C) and ulinastatin group(U). Group U received UTI and group C received same volume of normal saline instead of ulinastatin. Blood samples were taken from radial artery for determination of plasma TNF-α,IL-6,IL-8 and IL-10 concentration before CPB (T0), during CPB 30 min (T1), at the end of CPB (T2), 2 h after cessation of CPB (T3), 6 h (T4) and 24 h (T5). All of these was estimated by Enzyme-linked immunoadsordent assay (ELISA). Meanwhile, right atrial transmural samples were obtained at before and 30 min after CPB. In situ TUNEL technique was used for detecting apoptotic myocytes with pathological section of paraffin imbedding. Result The level of TNF-α,IL-6,IL-8 and IL-10 was significantly higher after cessation of CPB (T2-4 ) than that before CPB (T0) (P<0.01). The plasma TNF-α,IL-6,IL-8 concentrations were significantly lower while the IL-10 concentration was significantly higher in group U than in group C at T2～T5 (P<0.01). Plasma IL-10 concentration was positively correlated with plasma concentration of IL-6 and IL-8. 30 min after CPB, the number of TUNEL positive myocyte nuclei was significantly increased comparison with before CPB (P<0.01). The number of TUNEL positive myocyte nuclei was significantly lower in group U than that in group C (P<0.01). Conclusion Ulinastatin can reduce the plasma levels of TNF-α,IL-6,IL-8 and increase IL-10 in cardiac surgery under CPB. Ulinastatin can regulate cytokines balance and down-regulate inflammatory response. Ulinastatin is effective to reduce myocardial injury in CPB. Cardiopulmonary bypass could induce human cardiomyocyte apoptosis. Ulinastatin can inhibit myocardial cell apoptosis and effectively protect the myocardium from injury. |
