目的 探讨ω-3多不饱和脂肪酸对体外循环下心脏瓣膜置换术围术期患者炎性反应的影响。方法 选择解放军第305医院收治的需要行心脏瓣膜置换手术的患者62例,随机分为两组,每组31例。加用ω-3多不饱和脂肪酸[(尤文,0.2 g/(kg·d)],对照组给予等量生理盐水,并分别测定手术开始前,升主动脉阻断后0.5 h,体外循环结束后2 h,手术后12、24、48 h等时间点血浆中IL-6、TNF-α、IL-10的浓度。结果 与手术开始前(T0)比较,其余各时间点两组患者血中 TNF-α、IL-6、IL-10水平均升高,差异有统计学意义(P<0.05);与对照组比较,试验组其余各时间点血中TNF-α及IL-6水平均较低,IL-10水平则升高,差异有统计学意义(P<0.05)。结论 ω-3多不饱和脂肪酸对心脏瓣膜置换手术围术期炎性反应有一定程度的抑制作用。
Abstract
Objective To evaluate the impact of ω-3 polyunsaturated fatty acids on levels of IL-6,TNF-α and IL-10 in patients undergoing cardiac valve replacement.Methods Sixty-two patients undergoing cardiac valve replacement in No.305 Hospital of PLA were randomly divided into two groups:the trial group (n=31) and control group (n=31).The patients in the trial group were administered with ω-3 polyunsaturated fatty acids 0.2 g/(kg·d) while the control group was administered with saline.The plasma concentrations of IL-6,TNF - α and IL-10 were measured before surgery,0.5 h after ascending aorta occlusion,2 h after cardiopulmonary bypass,and 12,24,48 h after surgery.Results After surgery (T0),the levels of TNF-α,IL-6 and IL-10 in the two groups were increased (P<0.05).The serum levels of TNF-α and IL-6 in the trail group were lower than those of the control group,but the level of IL-10 was higher,with statistically significant difference.Conclusions ω-3 polyunsaturated fatty acids can attenuate the inflammatory response in patients undergoing cardiac valve replacement to some extent.
关键词
ω-3多不饱和脂肪酸 /
炎性反应 /
心脏瓣膜置换术
Key words
ω-3 polyunsaturated fatty acids /
inflammatory response /
cardiac valve replacement
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 张加强,张 卫.右美托咪定对风湿性心脏病合并肺高压患者行瓣膜置换术时血流动力学的影响[J].中国医院药学杂志,2014,34(6):469-472.
[2] Hall R I,Smith M S,Rocker G.The systemic inflammatory response to cardiopulmonary bypass:pathophysiological,therapeutic,and pharmacological consideration [J].Anesth Analg,1997,85:766-782.
[3] 许静红,肖亮灿,徐 夏,等.右美托咪定对成人瓣膜置换术围术期心肺保护作用 [J].齐鲁医学杂志,2016(4):414-416.
[4] 夏延平,苏宜香.Omega-3 多不饱和脂肪酸影响炎症及免疫分子机制研究进展[J].现代免疫学,2004,24(6):517-519.
[5] Hall R I,Smith M S,Roeker G.The systemiec inflammatory responseto cardiopulmonary bypass:pathophysiological,therapeutic,and pharmacological considerations[J].Anesth Analg,2007,85(4):766-782.
[6] 邓 莎,庄海滨.右美托咪定用于体外循环下心脏瓣膜置换术患者临床观察[J].临床军医杂志,2015,43(12):81-84.
[7] 钱方毅.重视心力衰竭发病机制中的神经内分泌细胞因子系统的研究[J].中国循环杂志,2001,16(4):243-251.
[8] 何 萍,刘志恒.右美托咪定对体外循环下全身炎症反应综合征的保护效果观察[J].中国药师,2017,20(8):1387-1390.
[9] Charman A,Muriithi E W,Milne E,et al.Fish oil before cardiac surgery:neutrophil activation is unaffected but myocardial damage is moderated[J].PLEFA,2005,72(4):257-265.
[10] Pepe S,McLennan P L.Cardiac membrane fatty acid composition modulates myocardial oxygen consumption and postischemic recovery of contractile function [J].Circulation,2012,105(19):2303-2308.
[11] Calder P C,Yaqoob P,Thies F,et al.Fatty acids and lymphocyle functions[J].BJN,2002,87 (Suppl 1):S31-48.
[12] Thies F,Nebe-von-Caron G,Powell J R,et al.Dietary supplementation with eicosapentaenoic acid,but not with other long-chain n-3 or n-6 polyunsaturated fatty acids,decreases natural killer cell activity in healthy subjects aged >55y [J].Clin Nutr,2011,73(3):539-548.
[13] Su K P,Huang S Y,Chiu C C,et al.Omega-3 fatty acids in major depressive disorder.A preliminary double-bind,placebo-controlled [J].PEN,2006,30(6):75-78.
[14] Ait-Said F,Elalamy L,Merts C,et al.Inhibion by eicosapentaenoic and acid of IL-1 beta-induced PGHS-2 expression in human microvascular endothelial cells:involvement of lipoxygenase-derived metabolites and p38MARK pathway [J].BBA,2003,20(2):77-84
[15] Leifert W R,McMurchie E J,Saint D A.Inhibition of cardiac sodium currents in adu1t rat myoeytes by n-3 polyunsaturated fatty acids [J].J Physiol,2009,520:671-679.
[16] Green P,Gispan-Herman I,Yadid G.Increased arachidonic acid concentration in the brain of Flinders Sensitive line rats,animal model of depression[J].Lipid Res,2015,46(6):1093-1096.
[17] 李秋荣,马 健,施 谦,等.多不饱和二十二碳六烯酸对白细胞介素-2α受体的抑制作用[J].肠外与肠内营养,2014,11 (6):324-328.
[18] 李秋荣,马 健,谭 力,等.二十二碳六烯酸改变脂筏脂肪微环境调节白细胞介素-2受体信号通路[J].中国科学,2005,35 (4):373-382.
PDF(652 KB)
