On-pump versus off-pump coronary artery bypass grafting: more heat-shock protein 70 is released after on-pump surgery
On-pump versus off-pump coronary artery bypass grafting: more heat-shock protein 70 is released after on-pump surgery
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DOI：
10.1016/j.ejcts.2004.03.002
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发表时间：
2004-06-01
影响因子：
3.4
通讯作者：
Sundan, A
中科院分区：
文献类型：
--
作者：
Dybdahl, B;Wahba, A;Sundan, A
目的：冠状动脉旁路移植术（CABG）中体外循环的使用可能会导致术后炎症反应。分子伴侣热休克蛋白（HSP）70可由缺血诱导，并且在CABG后的心肌和循环中都检测到。在体外，细胞外HSP 70可以激活先天性和适应性免疫。假设使用心肺转流（CPB）导致更多的循环HSP 70，我们探讨了它的释放在10例患者接受CABG与使用CPB，并在10例患者接受非体外循环手术CABG（OPCAB）。方法：分别于术前、术中2次、术后2 h、6 h及次日采血。通过免疫测定法进行血清分析。结果如下：我们检测到体外循环和非体外循环患者的术后循环HSP 70有显著差异（中位峰值分别为2849和756 pg/ml，P < 0.01，术后2 h）。所有患者的白细胞介素-6和-8均升高，组间无显著差异。10例体外循环患者中有7例在手术结束时血清白细胞介素-10升高（中位数为51.7 pg/ml），但无一例非体外循环患者。第一组IL-10与术后HSP 70浓度呈正相关，r = 0.75，P < 0.05。术后第1天，常规组患者的心肌损伤血清标志物高于非体外循环组患者：中位心肌肌钙蛋白T分别为0.358和0.126 mug/l，P < 0.01。相应地，中位肌酸激酶MB在体外循环和非体外循环患者中分别为23.6和7.8 μg/l，P < 0.01。HSP 70峰值与第1天测量的肌钙蛋白T和肌酸激酶MB相关。结论：常规冠状动脉旁路移植术比非体外循环冠状动脉旁路移植术释放更多的热休克蛋白70。循环HSP 70可能指示细胞应激或损伤。此外，热休克蛋白，建议作为免疫调节剂，并可能是重要的宿主防御手术后。(C)2004 Elsevier B. V.保留所有权利。
Objectives: The use of cardiopulmonary bypass in coronary artery bypass grafting (CABG) may contribute to the postoperative inflammatory response. The molecular chaperone heat-shock protein (HSP) 70 may be induced by ischemia, and has been detected both in the myocardium and in the circulation after CABG. In vitro, extracellular HSP70 may activate both innate and adaptive immunity. Hypothesizing that use of cardiopulmonary bypass (CPB) leads to more circulating HSP70, we explored the release of it in 10 patients undergoing CABG with the use of CPB, and in 10 patients undergoing off-pump surgery CABG (OPCAB). Methods: Blood samples were taken preoperatively, twice peroperatively, 2 and 6 h postoperatively and the next day. Serum analyses were performed by means of immunoassays. Results: We detected a significant difference in postoperative circulating HSP70 between on-pump and off-pump patients (median peaks of 2849 and 756 pg/ml, respectively, P < 0.01, 2 h postoperatively). Interleukin-6 and -8 increased in all patients, without significant differences between the groups. Serum interleukin-10 increased at the end of the operation in 7 of 10 patients operated with cardiopulmonary bypass (median 5 1.7 pg/ml), but in none of the off-pump patients. Furthermore, in the first group, interleukin-10 correlated with the HSP70 concentration at the end of the operation, r = 0.75, P < 0.05. Serum markers of myocardial damage were higher in conventional than off-pump patients on day I postoperatively: median cardiac Troponin T was 0.358 and 0.126 mug/l, respectively, P < 0.01. Correspondingly, median creatine kinase-MB was 23.6 and 7.8 μg/l in on-pump and off-pump patients, respectively, P < 0.01. Peak HSP70 correlated with both Troponin T and creatine kinase-MB measured on day 1. Conclusions: Significantly more HSP70 was released into the circulation following conventional than following off-pump CABG. Circulating HSP70 may indicate cellular stress or damage. Furthermore, HSPs, are suggested as immunoregulatory agents, and may be important in the host defence postoperatively. (C) 2004 Elsevier B.V. All rights reserved.