Dexamethasone Pretreatment Provides Antiinflammatory and Myocardial Protection in Neonatal Arterial Switch Operation
Dexamethasone Pretreatment Provides Antiinflammatory and Myocardial Protection in Neonatal Arterial Switch Operation
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DOI：
10.1016/j.athoracsur.2011.11.059
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发表时间：
2012-03-01
影响因子：
4.6
通讯作者：
Seghaye, Marie-Christine
中科院分区：
文献类型：
--
作者：
Heying, Ruth;Wehage, Edith;Seghaye, Marie-Christine
背景这项前瞻性双盲随机研究验证了地塞米松术前治疗可减弱心肌炎性启动、减少心脏手术后全身炎症反应并提供器官保护的假设。20名新生儿（年龄，8至21天）与大动脉转位计划动脉转换手术。9例在体外循环前4小时接受地塞米松（1 mg/kg体重），11例接受氯化钠。我们研究了心肌内白细胞介素（IL）-6，IL-8，IL-1 β和肿瘤坏死因子-α（TNF-α）的信使RNA表达，以及在CPB前取的右心房组织中IL-10和TNF-α的蛋白水平表达。我们测量了IL-6、IL-10、脂多糖结合蛋白和心肌肌钙蛋白T的血浆水平。细胞因子表达与术后疗效相关。地塞米松预处理导致心肌IL-6、IL-8、IL-1 β和TNF-α信使RNA表达显著降低，TNF-α蛋白合成减少。在预治疗患者中，IL-6的血浆浓度显著降低，IL-10的血浆浓度显著升高。这与较低的心肌肌钙蛋白T值和较低的多巴酚丁胺需求有关。脂多糖结合蛋白的水平显着高于术后预处理的大鼠。动脉转位术前给予地塞米松可导致大动脉转位新生儿心肌和全身细胞因子表达谱发生变化，促炎细胞因子下调，促炎细胞因子上调。较低的心肌细胞损伤和较低的儿茶酚胺需要量表明治疗患者的心肌保护作用。(Ann Thorac Surg 2012; 93：869 - 77）（C）2012年，胸外科医师协会
Background. This prospective double-blinded randomized study tested the hypothesis that preoperative treatment with dexamethasone would attenuate inflammatory priming of the myocardium, reduce the systemic inflammatory reaction upon cardiac operation, and provide organ protection in neonates.Methods. Twenty neonates (age, 8 to 21 days) with transposition of the great arteries scheduled for arterial switch operation were included. Nine received dexamethasone (1 mg/kg body weight) 4 hours before cardiopulmonary bypass, and 11 received natrium chloride. We studied intramyocardial messenger RNA expression of interleukin (IL)-6, IL-8, IL-1 beta, and tumor necrosis factor-alpha (TNF-alpha), as well as IL-10 and expression of TNF-alpha on protein level in right atrial tissue taken before institution of CPB. We measured plasma levels of IL-6, IL-10, lipopolysaccharide binding protein, and cardiac troponin T. Cytokine expression was related to postoperative outcome.Results. Pretreatment with dexamethasone led to a significant decrease in myocardial expression of IL-6, IL-8, IL-1 beta, and TNF-alpha messenger RNA and to a decrease in protein synthesis of TNF-alpha. Plasma concentrations of IL-6 were significantly lower and those of IL-10 significantly higher in pretreated patients. This was associated with lower cardiac troponin T values and lower dobutamine requirement. Levels of lipopolysaccharide binding protein were significantly higher postoperatively in pretreated neonates.Conclusions. Dexamethasone administration before arterial switch operation leads to a shift in the myocardial and systemic cytokine expression profile in neonates with transposition of the great arteries, with downregulation of proinflammatory and upregulation of antiinflammatory cytokines. Lower myocardial cell damage and lower catecholamine requirement suggest myocardial protection in treated patients. (Ann Thorac Surg 2012; 93: 869-77) (C) 2012 by The Society of Thoracic Surgeons