Plasma Levels of Receptor for Advanced Glycation End Products, Blood Transfusion, and Risk of Primary Graft Dysfunction
Plasma Levels of Receptor for Advanced Glycation End Products, Blood Transfusion, and Risk of Primary Graft Dysfunction
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DOI：
10.1164/rccm.200901-0118oc
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发表时间：
2009-11-15
影响因子：
24.7
通讯作者：
Ware, Lorraine B.
中科院分区：
文献类型：
--
作者：
Christie, Jason D.;Shah, Chirag V.;Ware, Lorraine B.
基本原理：晚期糖基化终末产物受体（receptor for advanced glycation end products，RECEPTOR）是肺上皮损伤的重要标志物，可能与肺泡液体清除功能受损有关。我们假设，肺移植后原发性移植物功能障碍（PGD）的患者将有较高的血浆中的sodium水平比patients without PGD.Objectives：To测试的协会可溶性sodium（sodium）水平与PG D在一个前瞻性的，多中心的队列study.Methods：我们测量了血浆sodium水平在6和24小时后，在7个中心的317例肺移植受者在同种异体移植再灌注。主要结果是在移植后的前72小时内3级PGD（Pa（O2）/Fi（O2）< 200，伴有肺泡浸润）。（分别为9.3 ng/ml对7.5 ng/ml; P = 0.028）和移植后24小时（分别为4.3 ng/ml对1.9 ng/ml; P < 0.001）。多变量逻辑回归分析表明，sodium和PGD水平之间的关系是由右心压力升高和使用心肺转流衰减。心肺转流受试者在6小时（P = 0.003）和24小时（P < 0.001）时的中位血清肌酐水平较高。6小时的血清肌酐水平与术中红细胞输注显著相关（斯皮尔曼P = 0.39，PGD患者P = 0.002），在多变量线性回归分析中，这种相关性与混杂变量无关（P = 0.02）。此外，血浆胰岛素水平与血液制品输注和心肺转流术的使用相关。
Rationale: The receptor for advanced glycation end products(RAGE) is an important marker of lung epithelial injury and may be associated with impaired alveolar fluid clearance. We hypothesized that patients with primary graft dysfunction (PGD) after lung transplantation would have higher RAGE levels in plasma than patients without PGD.Objectives: To test the association of soluble RAGE (sRAGE) levels with PG D in a prospective, multicenter cohort study.Methods: We measured plasma levels of sRAGE at 6 and 24 hours after allograft reperfusion in 317 lung transplant recipients at seven centers. The primary outcome was grade 3 PGD (Pa(O2)/Fi(O2) < 200 with alveolar infiltrates) within the first 72 hours after transplantation.Measurements and Main Results: Patients who developed PGD had higher levels of sRAGE than patients without PGD at both 6 hours (median 9.3 ng/ml vs. 7.5 ng/ml, respectively; P = 0.028) and at 24 hours post-transplantation (median 4.3 ng/ml vs. 1.9 ng/ml, respectively; P < 0.001). Multivariable logistic regression analyses indicated that the relationship between levels of sRAGE and PGD was attenuated by elevated right heart pressures and by the use of cardiopulmonary bypass. Median sRAGE levels were higher in subjects with cardiopulmonary bypass at both 6 hours (P = 0.003) and 24 hours (P < 0.001). sRAGE levels at 6 hours were significantly associated with intraoperative red cell transfusion (Spearman's P = 0.39, P = 0.002 in those with PGD), and in multivariable linear regression analyses this association was independent of confounding variables (P = 0.02).Conclusions: Elevated plasma levels of sRAGE are associated with PGD after lung transplantation. Furthermore, plasma sRAGE levels are associated with blood product transfusion and use of cardiopulmonary bypass.