Preoperative and postoperative endotoxemia in children with congenital heart disease
Preoperative and postoperative endotoxemia in children with congenital heart disease
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DOI：
10.1378/chest.117.6.1706
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发表时间：
2000-06-01
期刊：
影响因子：
9.6
通讯作者：
Giroir, BP
中科院分区：
文献类型：
--
作者：
Lequier, LL;Nikaidoh, H;Giroir, BP
研究目的：最近的数据表明，炎症细胞因子的增加是在心脏病患者中观察到的。然而，在心脏疾病期间细胞因子分泌的主要刺激仍然未知。由于细菌内毒素是一种强有力的细胞因子诱导剂，我们确定了先天性心脏病患儿手术修复前后内毒素血症的发生率、程度和临床相关性。设计：一项前瞻性观察性研究。地点：一家大型城市大学附属三级儿童医院。患者：30名患有各种先天性心脏病的儿童干预措施：在手术前和心肺转流后1、8、24、48和72小时采集血液，测定包括血浆内毒素、脂多糖结合蛋白（LBP）和白细胞介素-6（IL-6）。30例患者中有29例（96%）在研究期间有内毒素血症的证据。30例患者中有12例（40%）在手术前出现明显的内毒素血症。LBP是一种对细菌和内毒素有反应的血浆标记物，在心肺转流术后显著升高，IL-6的血浆水平也是如此。30例患者中有15例符合前瞻性定义的术后严重血流动力学紊乱标准。这些患者术前血浆LBP（p < 0.02）和血浆内毒素水平（p < 0.05）明显高于血流动力学紊乱不太严重的患者。术前内毒素血症患者的死亡率为25%，而术前无内毒素血症的患者无死亡率（p = 0.05）。结论：这些数据表明，先天性心脏病患儿的内毒素血症比以前怀疑的更常见，并与临床结局相关。我们的结论是，针对内毒素的临床试验将是必要的，以确定如果内毒素是一个因果，病原体在疾病的过程。
Study objectives: Recent data indicate that increases in inflammatory cytokines are seen in patients with disease cardiac diseases. However, the primary stimulus for cytokine secretion during cardiac illness remains unknown. Since bacterial endotoxin is a potent inducer of cytokines, we determined the incidence, magnitude, and clinical relevance of endotoxemia in children with congenital heart disease before and after surgical repair.Design: A prospective, observational study.Setting: A large, urban, university-affiliated, tertiary-care children's hospital.Patients: Thirty children with a variety of congenital heart defects (median age, 59 days; median weight, 4.0 kg) were sequentially enrolled.Interventions: Blood was sampled prior to surgery, and at 1, 8, 24, 48, and 72 h following cardiopulmonary bypass, Assays included plasma endotoxin, lipopolysaccharide-binding protein (LBP), and interleukin-6 (IL-6).Measurements and results: Twenty-nine of 30 patients (96%) had evidence of endotoxemia during the study period. Twelve of the 30 patients (40%) were significantly endotoxemic prior to surgery. LBP, a plasma marker that responds to bacteria and endotoxin, rose significantly following cardiopulmonary bypass, as did the plasma levels of IL-6. Fifteen of 30 patients met prospectively defined criteria for experiencing a severe hemodynamic disturbance ill their postoperative course. These patients had significantly higher preoperative plasma LBP (p < 0.02) and plasma endotoxin levels (p < 0.05), compared to patients with less-severely disturbed hemodynamics. Mortality was 25% in patients with preoperative endotoxemia, compared with no mortality in patients who were not endotoxemic before surgery (p = 0.05).Conclusions: These data demonstrate that endotoxemia in children with congenital heart disease is more common than previously suspected, and is associated with clinical outcomes. We conclude that clinical trials targeting endotoxin will be necessary to determine if endotoxin is a causal, etiologic agent in the disease process.