Nishiyama T, Hanaoka K
Surgical Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Crit Care Med. 2001 Nov;29(11):2106-10. doi: 10.1097/00003246-200111000-00010.
Blood transfusion induces polymorphonuclear leukocyte elastase (PMNE) and interleukin 6 (IL-6). IL-6 would activate neutrophils to release PMNE. Ulinastatin, a protease inhibitor, inhibits PMNE release by blood transfusion. The purpose of this study was to investigate whether the effects of ulinastatin on PMNE release by blood transfusion come through inhibition of IL-6.
Semirandomized, controlled clinical trial.
Surgical center in a university hospital.
Patients age 35-70 yrs undergoing gastrectomy were enrolled in this study until the four study groups had 12 patients each.
Half of the enrolled patients received ulinastatin at random. After surgery, patients were divided into the following four groups: group A received neither blood transfusion nor ulinastatin, group B received only blood transfusion, group C received only ulinastatin, and group D received both blood transfusion and ulinastatin. The infusion of ulinastatin 300,000 units was started at manipulation of the stomach in the group C and at the start of blood transfusion in the group D.
Segmented neutrophil count and plasma concentrations of PMNE and IL-6 were measured. In addition, PMNE and IL-6 concentrations in every unit of concentrated red blood cell transfused and these concentrations in the plasma of the recipient after every unit of transfusion were measured.
Blood transfusion increased plasma concentrations of PMNE and IL-6, and the PMNE release from segmented neutrophil. The increase of plasma PMNE but not IL-6 concentration after each unit of blood transfusion was inhibited by ulinastatin. However, ulinastatin did not inhibit the increase of plasma concentrations of PMNE and IL-6 by surgical stimuli of gastrectomy.
Ulinastatin 300,000 units might be useful to inhibit blood transfusion-induced increase of PMNE but not IL-6. The inhibition of PMNE increase by ulinastatin was independent of IL-6.
输血可诱导多形核白细胞弹性蛋白酶（PMNE）和白细胞介素6（IL-6）释放。IL-6会激活中性粒细胞以释放PMNE。乌司他丁是一种蛋白酶抑制剂，可抑制输血引起的PMNE释放。本研究旨在探讨乌司他丁对输血诱导的PMNE释放的影响是否通过抑制IL-6来实现。
半随机对照临床试验。
大学医院的外科中心。
年龄在35至70岁之间接受胃切除术的患者被纳入本研究，直至四个研究组每组有12名患者。
入选患者的一半随机接受乌司他丁治疗。术后，患者被分为以下四组：A组既不输血也不接受乌司他丁治疗，B组仅接受输血，C组仅接受乌司他丁治疗，D组既接受输血又接受乌司他丁治疗。C组在胃部操作时开始输注30万单位乌司他丁，D组在输血开始时开始输注。
测量分叶核中性粒细胞计数以及PMNE和IL-6的血浆浓度。此外，还测量了每单位浓缩红细胞输注液中的PMNE和IL-6浓度以及每单位输血后受血者血浆中的这些浓度。
输血增加了血浆中PMNE和IL-6的浓度以及分叶核中性粒细胞释放的PMNE。乌司他丁可抑制每单位输血后血浆中PMNE浓度的升高，但不抑制IL-6浓度的升高。然而，乌司他丁并不能抑制胃切除术手术刺激引起的血浆中PMNE和IL-6浓度的升高。
30万单位乌司他丁可能有助于抑制输血诱导的PMNE升高，但不能抑制IL-6升高。乌司他丁对PMNE升高的抑制作用与IL-6无关。
