Effect of ulinastatin preconditioning on myocardial injury of pediatric patients undergoing living related liver transplantation during neohepatic stage and its mechanism

WENG Yi-qi; YU Wen-li; DU Hong-yin; JIA Li-li; WANG Fei; WANG Yong-wang; SHENG Ming-wei; YU Yong-hao

doi:10.3969/j.issn.1002-266X.2015.35.001

Abstract：Objective To investigate the effect of ulinastatin preconditioning on myocardial injury of pediatric patients undergoing living related liver transplantation ( LRLT) during neohepatic stage and its mechanism.Methods Thirty chil-dren, scheduled for LRLT, were randomly divided into two groups (n=15):the observation group and the control group. Ulinastatin 20 000 U/kg was diluted into 10 000 U/mL with normal saline and it was then injected intravenously in 2 parts (1/2 was injected before skin incision;1/2 at 5 min before portal vein declamping) in the observation group.In the con-trol group, the equal volume of normal saline was given instead of ulinastatin.Blood samples were taken from the central vein before skin incision ( T0 , baseline) , at 30 min after anhepatic phase ( T1 ) , 3 h of neohepatic stage ( T2 ) and the end of surgery ( T3 ) for the determination.The Access2 electrochemiluminescence instrument was used to detect serum cardiac troponin I ( cTnI) and creatine kinase isoenzyme ( CK-MB) concentrations.LX-20 type full automatic biochemical analyzer was used to measure the lactate dehydrogenase ( LDH) activity.ELISA method was used to detect the levels of serum TNF-α, IL-6 and IL-18.Results The serum concentrations of cTnI were (0.043 ±0.023), (0.048 ±0.025), (0.205 ± 0.055) and (0.195 ±0.057) μg/L, the serum CK-MB concentrations were (1.4 ±0.4), (1.7 ±0.6), (3.4 ±1.1) and (4.1 ±1.5) μg/L, and the LDH activities were (225 ±78), (267 ±53), (280 ±45) and (446 ±135) IU/L at T0-3 in the observation group.The serum cTnI concentrations were (0.046 ±0.027), (0.051 ±0.027), (0.378 ± 0.084), (0.326 ±0.082) μg/L, the serum CK-MB concentrations were (1.6 ±0.5), (1.9 ±0.5), (4.2 ±0.8) and (5.3 ±1.7) μg/L, and the LDH activities were (254 ±85), (275 ±75), (339 ±87) and (577 ±156) IU/L at T0-3 in the control group.The serum cTnI, CK-MB concentrations and LDH activities were higher at T2-3 than at T0 in the two groups ( P<0.05 or P<0.01) .Compared with the control group, the serum cTnI, CK-MB concentrations and LDH activ-ities at T2-3 were significantly decreased in the observation group (P<0.05 or P<0.01).The serum TNF-αlevels were (34 ±10), (38 ±11), (142 ±45) and (121 ±41) pg/mL, the serum IL-6 levels were (65 ±21), (70 ±24), (85 ± 23) and (102 ±33) pg/mL, and the serum IL-18 levels were (16 ±4), (18 ±6), (60 ±21) and (114 ±43) pg/mL at T0-3 in the observation group.The serum TNF-αlevels were (35 ±11), (43 ±12), (186 ±62) and (163 ±57) pg/mL, the serum IL-6 levels were (72 ±15), (82 ±23), (113 ±42) and (171 ±56) pg/mL, and the serum IL-18 levels were (17 ±5), (20 ±7), (78 ±23) and (153 ±51) pg/mL at T0-3 in the control group.The serum levels of TNF-α, IL-6 and IL-18 were higher at T2-3 than at T0 in the two groups (P<0.05 or P<0.01).Compared with the control group, the serum levels of TNF-α, IL-6 and IL-18 at T2-3 were significantly decreased in the observation group ( P<0.05 or P<0.01).Conclusion Ulinastatin preconditioning can alleviate cardiac injury in pediatric patients undergoing LRLT in a certain extent, whose mechanism may be related to inhibiting the excessive release of inflammatory factors.