Abstract
Purpose
To investigate whether ulinastatin pretreatment (6000 U · kg−1 before CPB and before declamping of aorta) influenced the production of cytokines and adhesion molecules in the peripheral circulation.
Methods
This prospective randomized study was performed in 22 patients undergoing cardiac surgery. They were divided into two groups. Patients in Group I were untreated and in Group II treated with ulinastatin. The soluble intercellular adhesion molecule-1 (S-ICAM-1), soluble endothelial leukocyte adhesion molecule-1 (S-ELAM-1), interleukin8 and 6 (IL-8, 6) were measured using ELISA kits.
Results
Serum S-ICAM-1 concentration in Group I increased from the preoperative value of 297 ± 27 ng · kg−1 to 418 ± 106 ng · kg−1 at 60 min after declamping of the aorta (P < 0.01) but did not change in Group II. Serum S-ELAM-1 concentration did not change in either group. Serum concentration of IL-8 and IL-6 in Group I (37 ± 44 pg · kg−1, and 59 ± 59 pg · kg−1, preoperatively) increased to 169 ± 86 pg · kg−1 and 436 ± 143 pg · kg−1 at 60 min after declamping of the aorta (P < 0.001, P < 0.001). The increases were greater than those from 25 ± 6 pg · kg−1 and 30 ± 26 pg · kg−1 to 56 ± 36 pg · kg−1 and 132 ± 78 pg · kg−1 in Group II (P < 0.001, P < 0.001). The levels of S-ICAM-1 correlated with those of IL-8 (r = 0.5, P < 0.001).
Conclusion
These results suggest that ulinastatin may suppress the increase in IL-8 production and the expression of ICAM-1 during cardiac surgery.
Résumé
Objectif
Rechercher si le l’administration préalable d’ulinastatin (6000 U · kg−1 avant la CEC et au déclampage de l’aorte) influençait la production de cytokines et de molécules adhésives dans la circulation périphérique.
Méthodes
Cette étude prospective et aléatoire a été réalisée chez 22 patients soumis à une chirurgie cardiaque. Ils ont été répartis entre deux groupes. Les patients du groupe I n’ont pas reçu de l’ulinastatin alors que le groupe en a reçu. La molécule-1 adhésive intercellulaire soluble (S-1CAM-1), la molécule-1 endothéliale leucocytaire soluble (S-ALAM-1), les inlerleukines 8 et 6 (IL-8, 6) ont été mesurées à l’aide d’une trousse ELISA.
Résultats
La concentration sérique de S-ICAM-1 du groupe I a augmenté 60 min après le déclampage de l’aorte de la valeur préopératoire de 297 ± 27 ng · kg−1 à 418 ± 106 ng · kg−1 (P < 0,01) mais est demeurée inchangée dans le groupe II. La concentration sérique de IL-8 et IL-6 n’a pas changé dans les deux groupes. Les concentrations sériques de IL-8 et IL-6 dans le groupe I (valeurs préopératoires 37 ± 44 pg · kg−1 et 59 ± 59 pg · kg−1) ont a augmenté à 169 ± 86 pg · kg−1 et 436 ± 43 pg · kg−1 60 min après le déclampage de l’aorte (P < 0,001, P < 0,001). Les niveaux de S-ICAM-1 étaient en corrélation avec ceux de IL-8 (r = 0,5, P < 0,001).
Conclusion
Ces résultats suggèrent que l’ulinastatin peut supprimer l’augmentation de la production de IL-8 et se ICAM-1.
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Kawamura, T., Inada, K., Akasaka, N. et al. Ulinastatin reduces elevation of cytokines and soluble adhesion molecules during cardiac surgery. Can J Anesth 43, 456–460 (1996). https://doi.org/10.1007/BF03018106
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DOI: https://doi.org/10.1007/BF03018106