[Effects of ulinastatin on cerebral inflammatory response during cardiopulmonary bypass].
OBJECTIVE
To investigate the effects of ulinastatin (UTI) on cerebral inflammatory response during cardiopulmonary bypass (CPB).


METHODS
Twenty-four NYHA II-III patients (13 males and 11 females) aged 23-45 years, undergoing elective cardiac valve replacement under hypothermic CPB were randomly divided into 2 groups: ulinastatin group (Group U, n=12) and control group (Group C, n=12). In group U, UTI (1.2 x 10(4) U/kg) was given intravenously after the induction of anesthesia, 0.6 x 10(4) U/kg UTI was added to the priming solution, and 0.6 x 10(4) U/kg UTI was given about 5 min before the aortic decamping. In Group C, normal saline was given instead of UTI. Internal jugular vein was cannulated and the catheter was advanced retrogradely till jugular bulb. Blood samples were taken simultaneously from artery and jugular bulb after induction of anesthesia (T1), 60 min (T2) and 6 h (T3) after discontinuation of CPB for determination of TNFalpha, IL-6, IL-8 and IL-10. The juguloarterial gradients of these cytokines (deltaTNFalpha, deltaIL-6, deltaIL-8, and deltaIL-10) were calculated.


RESULTS
In Group C, arterial levels of TNFalpha, IL-6, IL-8, IL-10 at T2 and T3, deltaTNFalpha, deltaIL-8 and deltaIL-10 at T2, deltaTNFalpha, deltaIL-6 and deltaIL-10 at T3 significantly increased (P < 0.01). deltaIL-8 increased at T3 (P < 0.05). In Group U, arterial levels of IL-6, IL-8, IL-10 at T2, arterial levels of IL-6, IL-8,IL-L-10 and deltaTNFalpha, deltaIL-8 at T3 significantly increased (P < 0.01). Arterial levels of TNFalpha at T2 and T3, deltaTNFalpha, deltaIL-10 at T2, deltaIL-6 at T3 increased (P < 0.05). Arterial levels of TNFalpha, IL-6 and deltaTNFalpha, deltaIL-8 at T2, arterial levels of TNFalpha and deltaIL-6 at T3 in Group U were lower than those in Group C (P < 0.05). Arterial levels of IL-6 at T3, IL-8 at T2 and T3 in Group U were significantly lower than those in Group C (P < 0.01). Arterial levels of IL-10 and deltaIL-10 at T3 in Group U were higher than those in Group C (P < 0.05).


CONCLUSIONS
Systemic and cerebral activation of inflammatory response during CPB can be alleviated by ulinastatin.
Zou
Ding-quan
DQ
Department of Anesthesiology, Second Xiangya Hospital, Central South University, Changsha 410011, China. zoudingquan@sohu.com
Zhou
Jian-mei
JM
Chang
Ye-tian
YT
He
Xiao-jing
XJ
Yuan
Gui-xiu
GX
Wang
De-ming
DM
Luo
He-guo
HG
D000328:Adult; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004660:Encephalitis / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control*; D005260:Female; D006023:Glycoproteins / Q000627:therapeutic use*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D014361:Trypsin Inhibitors / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D006023:Glycoproteins; D015850:Interleukin-6; D016209:Interleukin-8; D014361:Trypsin Inhibitors; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; C028665:urinastatin