Alterations of Endothelial Glycocalyx During Orthotopic Liver Transplantation in Patients With End-Stage Liver Disease
Alterations of Endothelial Glycocalyx During Orthotopic Liver Transplantation in Patients With End-Stage Liver Disease
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DOI：
10.1097/tp.0000000000000680
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发表时间：
2015-10-01
期刊：
影响因子：
6.2
通讯作者：
Faybik, Peter
中科院分区：
文献类型：
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作者：
Schiefer, Judith;Lebherz-Eichinger, Diana;Faybik, Peter
背景内皮糖萼参与维持血管完整性，其扰动引起毛细血管渗漏、血管反应性丧失以及白细胞和血小板粘附增强。我们假设，糖萼核心蛋白syndecan-1的显著脱落发生在终末期肝病（ESLD）中，并且在原位肝移植（奥尔特）期间增加。我们进一步评估了全身麻醉对糖萼脱落的影响及其与奥尔特后急性肾损伤（阿基）的关系。患者和方法本前瞻性研究纳入了30例连续肝移植受者。10名健康志愿者作为对照。急性肾损伤由急性肾损伤网络标准定义。结果ESLD患者的血浆syndecan-1显著高于健康志愿者（74.3 +/- 59.9 vs 10.7 +/- 9.4 ng/mL），再灌注后进一步显著增加（74.3 +/- 59.9 vs 312.6 +/- 114.8 ng/mL）。全身麻醉的类型对syndecan-1没有显著影响。在整个研究期间，移植后阿基2期或3期患者的Syndecan-1显着高于阿基0期或1期患者。在再灌注后48小时内预测阿基2或3期的多配癸烷-1的受试者工作特征曲线的曲线下面积为0.76（95%置信区间，0.57-0.89，P = 0.005）。结论.终末期肝病患者存在糖萼改变，奥尔特过程中的缺血再灌注损伤进一步加重了其损害。尽管syndecan-1升高的患者阿基发生率较高，但对预测新发阿基没有帮助。挥发性麻醉剂不能减弱人奥尔特中的糖萼脱落。
Background. Endothelial glycocalyx participates in the maintenance of vascular integrity, and its perturbations cause capillary leakage, loss of vascular responsiveness, and enhanced adhesion of leukocytes and platelets. We hypothesized that marked shedding of the glycocalyx core protein, syndecan-1, occurs in end-stage liver disease (ESLD) and that it increases during orthotopic liver transplantation (OLT). We further evaluated the effects of general anesthesia on glycocalyx shedding and its association with acute kidney injury (AKI) after OLT. Patients andMethods. Thirty consecutive liver transplant recipients were enrolled in this prospective study. Ten healthy volunteers served as a control. Acute kidney injury was defined by Acute Kidney Injury Network criteria. Results. Plasma syndecan-1 was significantly higher in ESLD patients than in healthy volunteers (74.3 +/- 59.9 vs 10.7 +/- 9.4 ng/mL), and it further increased significantly after reperfusion (74.3 +/- 59.9 vs 312.6 +/- 114.8 ng/mL). The type of general anesthesia had no significant effect on syndecan-1. Syndecan-1 was significantly higher during the entire study in patients with posttransplant AKI stage 2 or 3 compared to patients with AKI stage 0 or 1. The area under the curve of the receiver operating characteristics curve of syndecane-1 to predict AKI stage 2 or 3 within 48 hours after reperfusion was 0.76 (95% confidence interval, 0.57-0.89, P = 0.005). Conclusions. Patients with ESLD suffer from glycocalyx alterations, and ischemia-reperfusion injury during OLT further exacerbates its damage. Despite a higher incidence of AKI in patients with elevated syndecan-1, it is not helpful to predict de novo AKI. Volatile anesthetics did not attenuate glycocalyx shedding in human OLT.