The Protective Effect Of Intratracheal Anti-tumor Necrosis Factor-α Antibody On Lung Injury After Cardiopulmonary Bypass

Title: The protective effect of intratracheal anti-tumor necrosis factor-αantibody on lung injury after cardiopulmonary bypass. Aim: To study the protective effect and its mechanism of anti-tumor necrosis factor-αantibody (TNF-αAb) on lung injury after cardiopulmonary bypass(CPB). Methods: (1) Animal experiment: 28 healthy rabbits were selected and randomly evenly divided into four groups: â… group received open chest operation; â…¡-â…£groups underwent CPB. In the â…£group, rabbit TNF-αAb (2400pg/kg) was dropped into the intracheal tube before operation and before releasing the aortic clamp. Saline was given to the â…¢group by the same way. Blood neutrophils count, TNF-α,MDA from the right and left atrium in the four groups were determined perioperatively. Water volume, TNF-αmRNA, TNF-αprotein, apoptosis and pathomorphological changes were measured in the lung tissues. (2) Clinical study: 20 patients with valve diseases undewent valve replacement under CPB. The patients were randomly divided into two groups: control group and TNF-αAb group. In the TNF-αAb group, human TNF-αAb (2.4μg/kg) was dropped into the intracheal tube before operation and just after releasing the aortic clamp. Nothing was given in the control group. Lung dynamic compliance and PaO₂/ FiO₂ which stands for oxygen changing rate; blood neutrophils count, TNF-α, MDA from the right and left atrium in both groups were determined perioperatively. The intube time was recorded. Results: Both animal experiment and clinical experiment show that TNF-αAb can restrain leukocyte accumulation, reduce releasing of TNF-αand MDA in the lung. Animal experiment demonstrates TNF-αAb can reduce the occurrence of apoptosis and attenuate pathomorphological changes in the lung tissue. But it can't reduce the secretion of TNF-αin the transcription level and protein level. Clinical experiment displays the dynamic compliances of the lung and PaO₂/ FiO₂ in TNF-αAb group was higher than that in control group. The intube time in TNF-αAb group was much shorter than that in control group. Conclusion: Intratracheal TNF-αAb has markedly protective effect on lung injury after CPB.