Pyruvate Dehydrogenase Activity and Quantity Decreases After Coronary Artery Bypass Grafting: a Prospective Observational Study.
Pyruvate Dehydrogenase Activity and Quantity Decreases After Coronary Artery Bypass Grafting: a Prospective Observational Study.
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DOI：
10.1097/shk.0000000000000306
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Donnino MW
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文献类型：
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作者：
Andersen LW;Liu X;Peng TJ;Giberson TA;Khabbaz KR;Donnino MW
丙酮酸脱氢酶(PDH)是有氧代谢中的关键守门酶。这项研究的主要目的是确定PDH活性是否受到冠状动脉旁路移植术(CABG)形式的主要应激的影响，CABG以前被用作危重疾病的模型。我们对在一家城市三级护理医院接受冠状动脉搭桥术的患者进行了一项前瞻性、观察性研究。我们纳入了接受冠脉搭桥术的成年患者，其中包括同期或不同期的瓣膜手术。分别于手术前、手术结束时和术后6小时测定PDH活性和数量及硫胺素。入选患者14例，年龄(67±10)岁，女性21%。研究对象术后PDH活性平均下降41.7%(SD：27.7%)，术后6小时平均下降32.0%(SD：31.4P<；0.001)。8名患者术后出现硫胺素缺乏(≤为7nmol/L)，而手术前没有患者(p=0.002)。硫胺素水平在各时间点均与PDH含量显著相关(p=0.01)。术后乳酸水平与术后硫胺素水平呈负相关(r=−0.58和p=0.04)。大手术应激导致PDH活性和数量下降，硫胺素水平下降。
Pyruvate dehydrogenase (PDH) is a key gatekeeper enzyme in aerobic metabolism. The main purpose of this study was to determine if PDH activity is affected by major stress in the form of coronary artery bypass grafting (CABG) which has previously been used as a model of critical illness. We conducted a prospective, observational study of patients undergoing CABG at an urban, tertiary care hospital. We included adult patients undergoing CABG with or without concomitant valve surgery. Measurements of PDH activity and quantity and thiamine were obtained prior to surgery, at the completion of surgery, and 6 hours post-surgery. Fourteen patients were enrolled (age: 67 ± 10 years, 21 % female). Study subjects had a mean 41.7 % (SD: 27.7) reduction in PDH activity after surgery and a mean 32.0% (SD: 31.4) reduction 6 hours after surgery (p < 0.001). Eight patients were thiamine deficient (≤ 7 nmol/L) after surgery compared to none prior to surgery (p = 0.002). Thiamine level was a significantly associated with PDH quantity at all time points (p = 0.01). Post-surgery lactate levels were inversely correlated with post-surgery thiamine levels (r = −0.58 and p = 0.04). The stress of major surgery causes decreased PDH activity and quantity, and depletion of thiamine levels.