Effect Of Ulinastatin On ICAM-1 And VCAM-1 On Myocardium During Cardiopulmonary Bypass

Objecticve To study the expression of intercellular adhesion molecule-1(ICAM-1) and vascular cell adhesion molecule-1(VCAM-1) on myocardium in the patients of heart valve replacement during cardiopulmonary bypass(CPB), and evaluate the effect of ulinastatin on its expression. Method Twenty ASAâ…¡-â…¢patients scheduled for heart valve replacement undergoing mild hypothermic CPB without cardioplegia were randomly divided into two groups of 10 patients in each: the controlled group (C) and the ulinastatin group (U).The patients with hepatorenal dysfunction or taking glucocorticoid or non-steroid anti-inflammatory drugs were excluded from. In group U ulinastatin 20 000u.kg-1 was added to the priming fluid ,in group C received normal saline instead of ulinastatin. The right atrium biopsies were obtained before CPB and at the end of CPB. Immunohistochemistry was applied to assay the expression of ICAM-1 and VCAM-1 on cardiac myocyte and myocardial vascular endothelia cell, which is quantitatively analysed by the value of grey . Result After CPB, the expression of ICAM-1 and VCAM-1 on myocardial vascular endothelia cell and cardiac myocyte were increased significantly in both groups compared with pre-CPB(P<0.05).Furthermore, after CPB the expression of ICAM-1 and VCAM-1 on myocardial vascular endothelia cell and cardiac myocyte in group C were increased significantly compared with group U (P<0.01). Conclusion The results indicate that ulinastatin may inhibit the expression of ICAM-1 and VCAM-1 on cardiac myocyte and myocardial vascular endothelia cell and may relieve the systemic inflammatory response induced by CPB.