RESUMO
Objective To study the effect of insulin on phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway in diabetic rats with myocardial ischemia reperfusion injury.Methods Diabetic rats were induced by high-sugar and high-fat diet plus intraperitoneal injection of streptozotocin (40 mg/kg).They were randomly divided into diabetic sham group (group A),diabetes ischemic reperfusion group (group B),diabetes ischemic reperfusion insulin treatment group (group C) and diabetic ischemia reperfusion + insulin Wortmaninn (PI3K inhibitors) group (group D),10 in each group.Myocardial ischemia reperfusion model in diabetic rats:heart was exposed between the third and fourth ribs of the left chest,2 mm from the lower edge of the left atrial ear,and 5-0 sterile suture was used to ligate the anterior descending coronary artery (LAD) and the great cardiac vein for 30 min,and then the perfusion was resumed for 120 min.Wortmannin (15 μg/kg) was given through femoral vein 20 min before ligation in group D,and the same amount of normal saline was given in the other 3 groups.Insulin (2 U/kg) was injected subcutaneously in group C and D 10 min before ligation,and the same amount of normal saline was injected subcutaneously in group A and group B.Plasma creatine kinase MB (CK-MB)and troponin Ⅰ (cTnⅠ) levels were measured in arterial blood after 120 min of reperfusion,and PI3K and Akt expression in myocardial tissue were detected by Western blot.Results Compared with the group A,the plasma levels of cTnI and CK-MB increased and the expressions of PI3K and phosphorylated protein kinase B (p-Akt) in myocardium decreased in the group B (P ＜ 0.05).After insulin treatment,the plasma cTnI [(0.89 ± 0.26) μg/L],CK-MB [(9.24 ±3.16) μg/L] in the myocardial tissue of the group C decreased,while the expression of PI3K (0.341 8 ±0.03 1) and p-Akt (0.673 1 ±0.028) in the myocardial tissue increased (P ＜0.05).After insulin + Wortmaninn administration,the plasma cTnI [(1.16 ±0.29) μg/L] and CK-MB [(12.57 ± 3.01) μg/L] in the group D increased,while the expression of PI3K (0.292 7 ± 0.036) and p-Akt (0.531 4 ± 0.030) in the myocardial tissue decreased,with statistically significant difference (P ＜ 0.05).Conclusions Insulin can reduce serum CK-MB and cTnⅠ levels in diabetic rats with myocardial ischemia reperfusion injury,possibly by activating PI3K/Akt signal transduction pathway,inhibiting myocardial enzyme release,and improving myocardial ischemia reperfusion injury in diabetic rats to play a protective role in myocardial cells.
RESUMO
Objective To investigate the effect of Xuebijing injection on inflammatory factors in patients with Stanford B aortic dissection (AD) after endovascular repair and approach its clinical significance.Methods Sixty patients with Stanford type B AD for endovascular repair admitted to the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine (TCM) from January 2014 to June 2016 were enrolled, and they were divided into a Xuebijing group and a control group according to the random number table method, 30 cases in each group. The patients of Xuebijing group received 100 mL Xuebijing injection+ 50 mL normal saline intravenous drip during operation, while the patients of control group received an equal volume of normal saline, 2 times a day in both groups for consecutive 3 days. Peripheral venous blood was collected before and after treatment for 1, 2, and 3 days, and the levels of C-reactive protein (CRP), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA), and the prognosis of the two groups was observed.Results With the prolongation of time, the postoperative levels of CRP, TNF-α and IL-6 in the two groups showed a tendency of first increase and then decrease compared with the preoperative levels, the above indexes of the two groups were all significantly higher, CRP (mg/L) and TNF-α (ng/L) peaked on the 2nd day postoperatively (control group: CRP was 146.34±13.92 and TNF-α was 72.22±7.63, Xuebijing group: CRP was 114.92±9.89 and TNF-α was 53.44±6.80, allP < 0.05), however, IL-6 (ng/L) peaked on the 1st day postoperatively (control group: 146.08±10.29, Xuebijing group: 117.88±8.84), then decreased, all reached the valley on the 3rd day postoperatively (control group: CRP, TNF-α, IL-6 was 112.59±8.54, 43.73±4.10, 70.03±4.66 respectively, Xuebijing group CRP, TNF-α, IL-6 was 87.75±7.67, 39.43±4.63, 56.65±3.27, respectively), and at the same time point, the level of CRP, TNF-α, IL-6 in the Xuebijing group were significant lower than those in the control group, the change were the most significant on 3 days after operation [CRP (mg/L): 87.75±7.67 vs. 112.59±8.54, TNF-α (ng/L): 39.43±4.63 vs. 43.73±4.10, IL-6 (ng/L): 56.65±3.27 vs. 70.03±4.66, P < 0.05]. There were no serious complications such as renal failure, severe hypoxemia, infection, paraplegia, stent shift and so on, no hospital death occurred and all patients were discharged in rehabilitative condition. Conclusions Endovascular repair in patients with Stanford type BAD may activate an inflammatory response inducing the release of a large amount of inflammatory factors during the early postoperative period, Xuebijing injection can inhibit the inflammatory reaction and prevent the occurrence of postoperative complications.