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背景与目的：有研究表明甲基强的松龙可减轻体外循环所致的肺损伤,但其对体外循环患者术后肾功能损害的作用尚不十分清楚。本文探讨甲基强的松龙是否有效抑制体外循环心内直视术中的炎症反应，并对肾脏有保护作用。方法：随机选取40例体外循环下择期行心脏瓣膜置换手术的患者，年龄30～55岁，心功能Ⅱ～Ⅲ级，随机分为甲基强的松龙组和对照组，每组20例。甲基强的松龙（MPS）组于体外循环前以甲基强的松龙10mg/kg预冲，对照组(NS)以等量的生理盐水代替。于CPB 前(T1),CPB 结束后2h (T2) 、CPB 结束后12h(T3), CPB 结束后24h(T4),等时点留取中心静脉血和尿液，以酶联免疫吸附实验（ELISA）法检测炎性介质(IL-6、TNF-α、IL-10)；取尿上清液检测反映肾功能的早期敏感指标：尿-N- 乙酰氨基- 葡萄糖苷酶（NAG）、尿α1- 微球蛋白 (α1-MG)、尿视黄醇结合蛋白(RBP)的水平。结果：CPB 前两组炎性介质和肾功检测指标，差异均无统计学意义(P>0.05)，而CPB 结束后，两组炎性介质的水平和肾功各项指标均较术前增高。与NS相比，MP组T2 ~ T4 时点IL-6水平明显降低(P<0.05)。在T2 ~ T3 时点TNF-α的水平明显低于对照组(P<0.05)。两组IL-10 的水平在CPB 后均增加，但在T2 ~ T3 时点MP组升高幅度明显高于NS组(P<0.05)。与NS比较，MP组在CPB后各时点尿NAG、α1-MG、RBP的水平均明显降低(P<0.05)。结论：CPB可导致全身炎性反应及肾功能损伤；甲基强的松龙可减轻炎性反应，同时对肾功能有一定的保护作用。

英文摘要:

Objective: To evaluate whether Methylprednisolne Sodium Succinate (MPS) may inhibit inflammatory reaction efficiently or not. And to protect renal function in adults undergoing CPB. Methods: Forty patients at ages of 30-55 years old with cardiac function class Ⅱ or Ⅲ, undergoing cardiac valve replacement with CPB, were randomly divided into two groups (n=20 each): control and MPS-treated. The patients in the MPS-treated group received Methylprednisolne Sodium Succinate of 10 mg/kg in 50 mL normal saline by adding it into the priming solution before CPB. The control group received 50 mL of normal saline instead. The serum levels IL-6, TNF-a and IL-10 were measured before CPB (T1), and 2 (T2), 12 (T3), and 24 (T4) hrs after CPB. As well as N-acetyl-D-Glucosaminidase (NAG), urinary-α1-microglobin and retinol-binding-protein (RBP) were measured at the four time points. Results: Before CPB there is no remarkable difference between two groups in neither levels of inflammatory cytokines nor parameters of renal function (P>0.05), whereas all the levels of those were higher after CBP. As compared with those in the control group , the serum level of IL-6 at T2-4, TNF-α at T2-3, were much lower in the MPS-treated group (P<0.05). MPS-treated group demonstrated a significant increase in levels of IL-10 at T2-3, compared with the group NS. At T2-4 points, these concentrations of urinary-α1-microglobin, urinary NAG and retinol-binding-protein (RBP) were significantly lower than those in the control group(P<0.05). Conclusion: CPB could induce systemic inflammatory reaction syndrome (SIRS) and renal failure. Methylprednisolne Sodium Succinate in CPB may protect the patients from SIRS and can protect renal function to some certain extent.

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