Department of General and Vascular Surgery, Faculty of Medicine, University of Pécs, Pécs, Hungary.
Clin Hemorheol Microcirc. 2010;44(2):125-36. doi: 10.3233/CH-2010-1260.
The challenge against reperfusion injury and tissue oxidative stress, especially in vascular surgical interventions has an essential importance to reach the optimal clinical result. Numerous experimental attempts have proved the positive antioxidant effect of vitamin E in both chronic and acute phase models. In our study we monitored the effect of continuous preoperative treatment with vitamin E, on oxidative stress and tissue inflammation reactions developed after reconstructive operations.
32 patients have been involved in a randomized, prospective study, all suffering from AFS occlusion proved by angiography, and all undergone supragenual reconstruction. Duration of ischemia and amount of tissues under vascular clamping were almost the same in all patients. In the group treated with E-vitamin, we administered 1 x 200 mg of vitamin E p/o from the preoperative day till the 7th post operative day. Patients of the second group did not receive vitamin E.
Peripheral blood samples were collected immediately before operation and at the end of the second reperfusion hour (early reperfusion period). Late reperfusion period has been monitored by analyzing blood samples taken at 24th hour and 7th day next to the operative ischemia. Among oxidative stress parameters, direct measurement of reactive oxygen intermediator (ROI) and determination of antioxidant state (GSH, Total-SH group, SOD) have been performed. Malondialdehyde was chosen as marker for lipidperoxidation. Inflammation reactions were monitored up on expression of adhesion molecules (CD11a and CD18). We also controlled the oscillation of myeloperoxidase (MPO) activity.
Our study has proved that preoperative (from the preoperative day till the 7th post operative day) administration of 200 mg vitamin E could reduce the level of oxidative stress developed after ischemic-reperfusion insult (lipidproxidation, antioxidant enzymes). According to our results, the prooxidant-antioxidant imbalance also diminished in the group with E-vitamin treatment. We proved that elective administration of vitamin E could decrease the WBC activity (MPO activity, free radicals production, expression of adhesion molecules) and its consequential local inflammation process, during early reperfusion.
对抗再灌注损伤和组织氧化应激的挑战，尤其是在血管外科手术中，对于达到最佳临床效果具有重要意义。大量的实验尝试已经证明了维生素 E 在慢性和急性模型中具有积极的抗氧化作用。在我们的研究中，我们监测了术前连续使用维生素 E 对重建手术后发生的氧化应激和组织炎症反应的影响。
32 名患者参与了一项随机、前瞻性研究，所有患者均经血管造影证实为 AFS 闭塞，并接受了肱骨上重建。所有患者的缺血时间和受血管夹夹闭的组织量几乎相同。在接受维生素 E 治疗的组中，我们从术前一天开始每天给予 1 次 200mg 维生素 E 口服，直到术后第 7 天。第二组患者未接受维生素 E 治疗。
在手术前和第二次再灌注后 1 小时（早期再灌注期）立即采集外周血样本。通过分析手术缺血后第 24 小时和第 7 天的血液样本监测晚期再灌注期。在氧化应激参数中，直接测量活性氧中间产物（ROI）并测定抗氧化状态（GSH、总 SH 组、SOD）。选择丙二醛作为脂质过氧化的标志物。监测黏附分子（CD11a 和 CD18）的表达来监测炎症反应。我们还控制髓过氧化物酶（MPO）活性的波动。
我们的研究证明，术前（从术前一天到术后第 7 天）给予 200mg 维生素 E 可以降低缺血再灌注损伤后发生的氧化应激水平（脂质过氧化、抗氧化酶）。根据我们的结果，在接受维生素 E 治疗的组中，促氧化剂-抗氧化剂失衡也减少了。我们证明，选择性给予维生素 E 可以减少白细胞（MPO 活性、自由基产生、黏附分子表达）的活性及其随后的早期再灌注期间的局部炎症过程。
