Caspase-3 在心脏不停跳与停跳二尖瓣置换术心肌表达的研究
| 作者: |
1马宪鲁,
1张申,
2郑宝石,
2谢晓勇
1 济宁市第一人民医院心外科，山东 济宁 272011 2 广西医科大学第一附属医院心外科，南宁 530021 |
| 通讯: |
郑宝石
Email: zhengbs25@vip.sina.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.11.021 |
| 基金: | 广西科学研究与技术开发计划项目, 1355005-2-3 广西自然科学基金项目, 2013GXNSFAA192052 |
摘要
目的：探讨Caspase-3在心脏不停跳与停跳二尖瓣置换术对心肌的表达。方法：40例风湿性心脏病(rheumatic heart disease，RHD)二尖瓣狭窄(mitral stenosis，MS)患者按照区组随机化方式分为心脏不停跳组20例(BH组，n=20)与心脏停跳组(CA组，n=20)20例，分别接受体外循环(cardiopulmonary bypass，CPB)下心脏不停跳与停跳二尖瓣置换术(mitral valve replacement，MVR)。于CPB开始前(T0)、主动脉阻断后30 min(BH组取相应时间，T1)以及缝合右心房(T2)时收取右心房心肌组织，应用逆转录聚合酶链式反应(RT-PCR)检测心肌Caspase-3的mRNA表达水平，应用免疫组化染色法对心肌切片染色观察，TUNEL法检测心肌细胞凋亡。结果：BH组Caspase-3在T2时表达量增高(P<0.05)，CA组在T1时有少量表达，在T2时表达量显著提高(P<0.05)；CA组Caspase-3表达量在T2时明显高于BH组(P<0.05)；两组Caspase-3在T2时阳性着色数增高(P<0.05)，CA组在T2时阳性着色数明显高于BH组(P<0.05)；BH组心肌细胞凋亡指数在T2时段明显低于CA组(P<0.05)。结论：心脏不停跳MVR能够通过降低Caspase-3表达来减轻CPB过程中心肌缺血再灌注对心肌的影响。
关键词：
体外循环
心肌缺血再灌注
二尖瓣置换术
Caspase-3
The study on the expression of myocardial Caspase-3 in mitral valve replacement with beating heart and cardiac arrest
CorrespondingAuthor: ZHENG Baoshi Email: zhengbs25@vip.sina.com
DOI: 10.3978/j.issn.2095-6959.2016.11.021
Abstract
Objective: To study the influence on the expression of myocardial Caspase-3 by beating heart and cardiac arrest mitral valve replacement (MVR) surgery. Methods: The forty patients selected from January 2015 to January 2016 in Jining NO.1 People’s Hospital Jining with rheumatic heart disease mitral stenosis were randomly divided into beating heart group (BH group, n=20) and cardiac arrest group (CA group, n=20), both of them were accepted MVR by beating heart surgery and cardiac arrest surgery under cardiopulmonary bypass (CPB) respectively. Right atrial myocardial tissue was collected at prior the start of CPB (T0), after aortic cross-clamping 30 min (BH group take the corresponding time, T1) and stitched right atrium (T2) respectively. The level of Caspase-3 mRNA was detected by RT-PCT at three time periods in two groups; the myocardial slices were deserved by immunohistochemical staining; the myocardial cell apoptosis were estimated by TUNEL. Results: The expression of Caspase-3 in BH group significantly increased in T2 than that before operation (P<0.05). Caspase-3 in CA group expressed a little at T1 but significantly increased in T2 (P<0.05). Caspase-3 in CA group expressed higher than that in BH group at T2 (P<0.05). The number of positive staining of Caspase-3 increased in two groups at T2 (P<0.05) and CA group was higher than BH group in T2 (P<0.05). The myocardial apoptosis index of BH group was lower than CA group. Conclusion: MVR on beating heart can reduce the expression of myocardial Caspase-3 to reduce the myocardial ischemia-reperfusion injury.