Effects Of Ulinastatin Treatment On Endotoxin And Inflammatory Response During On-pump Coronary Revascularisation

Objective To study the treatment effects and significance of ulinastatin on endotoxin and inflammatory response during on-pump coronary revascularistion.Methods In this study, prospective, randomized and double-blinded study,58 first-time coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) were randomly divided into 2 groups:U group (n=30) received a total dose of 20000 U/kg ulinastatin and C group (n=28) received placebo. Blood samples were obtained from radial artery for determination of plasma tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and lipopolysaccharide (LPS) concentrations after intubation (T1),30 min following clamping (T2), reperfusion (T3), 1 h after CPB (T4) and 3h after CPB (T5) respectively.Results(1) There was no significant difference in the plasma concentrations of TNF-alpha, IL-6 and LPS at T1 among the two groups (P>0.05), but increased at T2—T5 as compared with the T1 in two groups (P<0.05 or P<0.01).(2) Compared with the control group, the plasma levels of TNF-alpha and IL-6 of U group were significantly lower (P<0.05 or P<0.01).(3) There was no significant difference in LPS concentrations among the two groups (p>0.05). But the plasma levels of LPS gradually increased in both groups, the levels of T2—T5 were higher than T1 (p<0.05), the levels of T3 were significantly higher than T1 (p<0.01).(4)The levels of TNF-alpha and IL-6 were positive correlated with LPS in each group.Conclusions Results suggest that ulinastatin can significantly inhibit the inflammatory cytokine release and reduce the inflammatory response during the CPB, but it fails to decrease the LPS concentrations during CPB.