【摘要】 目的:探讨白细胞磷脂酶D（PLD）在心肺转流术（CPB）致全身性炎症反应过程中的作用及甲泼尼龙和抑肽酶对PLD活性的影响。方法:42例接受CPB心脏直视手术病人,分为对照组、甲泼尼龙组和抑肽酶组,患者于术前、心肺转流术中及术后8个不同时点采集动脉血,测定白细胞PLD活性,并检测髓过氧化物酶活性、CD11b表达及血浆IL-6、IL-8和C-反应蛋白的含量。结果:在升主动脉开放时点,对照组白细胞PLD活性为（18±8）nmol choline·h^-1·mg^-1,明显高于术前;甲泼尼龙组为（10±6）nmol choline·h^-1·mg^-1,明显低于对照组,但与术前相比差别无显著意义;甲泼尼龙组白细胞PLD活性升高时点后移至停CPB即刻点;抑肽酶组PLD活性与对照组相比差别无显著意义;但两药均不同程度降低CPB围术期血浆中IL-6、IL-8和C-反应蛋白水平及MRO活性、白细胞CD11b表达。结论:CPB致全身炎症反应过程中白细胞的PLD活性持续升高;甲泼尼龙部分抑制CPB引起的炎症反应,其抗炎机制与抑制PLD有关。更多还原

【Abstract】 AIM: To investigate the role of leukocyte phoshpolipase D (PLD) in systemic inflammatory response induced by cardiopulmonary bypass ( CPB) and the effects of methylprednisolone and aprotinin on leukocyte PLD activity. METHODS: Forty-two patients who received CPB open heart surgery were divided into 3 groups; methylprednisolone group, aprotinin group, and control group. Arterial blood (10 mL) was collected for assay of leukocyte PLD activity, myeloperoxidase ( MPO) activity, and CD11b expression at 8 different time points in perioperative period. Plasma IL-6, IL-8, and C-reactive protein levels were also determined. RESULTS: At the time point of ascending aorta declamped, leukocyte PLD activity for control group was (18 + 8) nmol choline·h-1·mg-1, which was higher than that of pre-CPB (P <0.01); the PLD activity for methylprednisolone group was (10+6) nmol choline·h-1·mg-1 that was lower than control ( P < 0.05), while it had no statistical difference compared with that of pre-CPB. In methylprednisolone group, PLD activity elevation was postponed to the time point of CPB stopped. There was no statistical difference in PLD activity between aprotinin group and control (P > 0.05). After administration of methylprednisolone or aprotinin, leukocyte CD11b expression, plasma IL-6, IL-8, C-reactive proteinlevels, and MPO activity decreased by different extent. CONCLUSION: Leukocyte PLD activity was elevated significantly in systemic inflammatory response induced by CPB and methylprednisolone partially blunted the CPB-induced inflammatory response by inhibiting PLD activity.更多还原