摘要目的 观察乌司他丁( ulinastatin,UTI)能否抑制自主循环恢复(restoration of spontaneous circulation,ROSC)后新西兰兔血浆致炎因子TNF-α、IL-6水平的升高,改善心功能、保护海马CA1区神经元细胞.方法 建立新西兰兔心搏骤停模型,ROSC后随机(随机数字法)分为对照组和UTI治疗组.观察ROSC后血浆TNF-α和IL-6水平的变化,监测心肌收缩和舒张功能；观察海马CA1区神经元细胞损伤和各主要脏器炎症细胞浸润的情况.依据正态检验结果用t检验或秩和检验( Mann-Whitney rank),多重比较用POST HOC检验,炎症因子和心功能的相关分析采用Pearson相关分析.结果 UTI显著抑制ROSC后TNF-α和IL-6水平的升高,UTI组ROSC后各时间点TNF-α和IL-6水平均低于对照组.UTI组动物ROSC后4、8、12 h的左心室射血分数(EF)、二尖瓣E/A峰比值高于对照组,左心室缩短分数(FS)值在ROSC后4、8h高于对照组,差异具有统计学意义(P＜0.05).Pearson相关分析表明ROSC后TNF-α和IL-6水平与EF明显相关.CA1区有活力的神经元细胞数对照组为(13.22 ±0.97),UTI组为(16.89±1.45),差异具有统计学意义(P=0.003);对照组的凋亡神经元细胞数为(15.67±1.37),UTI组为(13.67±1.03),差异具有统计学意义(P =0.019).UTI可以减轻ROSC后肠道、肝脏和肾脏内炎症细胞的浸润.结论 UTI通过减轻ROSC后兔肠道、肝脏和肾脏内炎症细胞的浸润,使血浆致炎因子TNF-α和IL-6水平降低,从而改善心功能和保护海马CA1区神经元细胞.

abstractsObjective To investigate whether Ulinastatin (UTI) would minimize the systemic inflammatory response,lessen cardiac dysfunction and protect neurons against injury in hippocampus CA1area after restoration of spontaneous circulation (ROSC). Methods Animal models of cardiac arrest were established in 24 New Zealand rabbits,and those animals were randomly (random number) divided into control group and UTI treated group after ROSC.Changes in the levels of plasma inflammatory cytokines TNF-α and IL-6 were assayed before cardiac arrest and 4,8,12 and 16 hours after ROSC.Cardiac function including FS,EF and E/A were observed with ultrasonography before cardiac arrest and 4,8,12 and 16hours after ROSC,and viable and apoptotic neurons in hippocampus CA1 area and infiltrations of MPO positive cells in myocardium,cerebrum,liver,kidney and intestine were counted 72 hours after ROSC.The t-test or Mann-Whitney rank sum test was used to verify the specified theoretical distribution functions of the biomarkers tested by Kolmogorov-Smirnov test,POST HOC test was used for the multiple comparisons,and Pearson correlation analysis was used to investigate the correlation between inflammatory cytokines and cardiac function. Results The levels of TNF-α and IL-6 in UTI group were lower than those in control group as those data got 4,8,12 and 16 hours after ROSC (P ＜0.05).EF and E/A in UTI treated group were higher than those in the control group as those data got 4,8,12 hours after ROSC.FS values obtained 4 h and 8 hours after ROSC were higher in UTI group than those in control group ( P ＜ 0.05 ).The Pearson correlation analysis showed that the levels of TNF-α and IL-6 significantly correlated with EF after ROSC.The number of viable neurons in CA1 area of control group was ( 13.22 ± 0.97) which was lower than that in UTI group ( 16.89 ± 1.45 ) ( P =0.003 ),while the number of apoptotic neurons in hippocampus CA1 area was higher in control group than that in UTI group (15.67 ± 1.37) vs.(13.67 ± 1.03 ) (P =0.019).The numbers of MPO positive cells were significantly lower in liver,kidney and intestine in group UTI than those in control group. Conclusions UTI could inhibit the infiltration of MPO positive cells in liver,kidney and intestine,decreasing the levels of TNF-α and IL-6 in plasma,in turn lessening cardiac dysfunction and protecting neurons from injury in hippocampus CA1 area after ROSC of New Zealand rabbits.