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目的:探讨Akt信号通路在紫绀型先天性心脏病患儿心肌慢性缺氧适应中的意义。方法:收集紫绀型和非紫绀型先天性心脏病患儿共50例,其中紫绀型26例(紫绀组),动脉血氧饱和度(SaO2)60%～89%;非紫绀型24例(非紫绀组),SaO2>95%,均不伴肺动脉高压[肺动脉收缩压<30mmHg(1mmHg=0.133kPa)]。心脏外科手术体外循环前留取右心耳组织,应用Western blot方法检测心肌组织蛋白激酶B(总Akt)和磷酸化蛋白激酶B(Ser473P-Akt)表达水平,免疫组织化学技术检测心肌组织总Akt和Ser473 P-Akt蛋白表达部位与水平。结果:与非紫绀组相比,紫绀组患儿心肌组织Ser473P-Akt蛋白表达水平明显增高(P<0.01),而2组患儿总Akt蛋白表达水平差异无统计学意义(P>0.05)。紫绀组患儿心肌组织Ser473P-Akt蛋白大部分表达在心肌细胞的胞质,胞核亦有微弱表达,而非紫绀组心肌细胞则无明显Ser473P-Akt蛋白表达。2组患儿总Akt蛋白绝大部分也表达在心肌细胞的胞质,胞核亦有微弱表达,但表达部位和水平差异无统计学意义。紫绀组患儿心肌组织Ser473 P-Akt蛋白表达水平与患儿术前SaO2呈负相关(r=-0.771,P<0.01)。结论:Akt信号通路激活可能是紫绀型先天性心脏病患儿心肌慢性缺氧适应的重要信号调控机制之一。
Objective: To investigate the significance of Akt signaling pathway in chronic hypoxic adaptation in children with cyanotic congenital heart disease. Methods: A total of 50 children with cyanotic and non-cyanotic congenital heart disease were collected, including 26 cyanotic cyanotic group (cyanotic group), 60% -89% arterial oxygen saturation (SaO2), 24 non-cyanotic Cyanotic group), SaO2> 95%, were not associated with pulmonary hypertension [pulmonary artery systolic blood pressure <30mmHg (1mmHg = 0.133kPa)]. Right atrial appendage was collected before cardiopulmonary bypass. Cardiac protein kinase B (Akt) and phosphorylated protein kinase B (Ser473P-Akt) were detected by Western blot. Immunohistochemistry was used to detect the expression of total Akt Ser473 P-Akt protein expression levels and levels. Results: Ser473P-Akt protein expression was significantly increased in cyanotic group compared with non-cyanotic group (P <0.01). There was no significant difference in total Akt protein expression between the two groups (P> 0.05). Ser473P-Akt protein in cyanotic group was mostly expressed in the cytoplasm and nucleus of cardiomyocytes. However, no significant expression of Ser473P-Akt protein was found in non-cyanotic group. The majority of total Akt protein in the two groups was also expressed in the cytoplasm and nucleus of cardiomyocytes, but there were no significant differences in the expression sites and levels. The expression of Ser473 P-Akt protein in cyanotic group was negatively correlated with preoperative SaO2 (r = -0.771, P <0.01). Conclusion: The activation of Akt signaling pathway may be one of the important signal regulation mechanisms of chronic hypoxia adaptation in children with cyanotic congenital heart disease.