Cardiopulmonary Bypass-Induced Inflammation and Myocardial Ischemia and Reperfusion Injury Stimulates Accumulation of Soluble MER.
Cardiopulmonary Bypass-Induced Inflammation and Myocardial Ischemia and Reperfusion Injury Stimulates Accumulation of Soluble MER.
复制标题
心肌缺血再灌注损伤和心肌炎性反应刺激可溶性MER的积累。
DOI：
10.1097/pcc.0000000000002725
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发表时间：
2021-09-01
期刊：
影响因子：
--
通讯作者：
Thorp EB
中科院分区：
文献类型：
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作者：
Becker AC;Lantz CW;Forbess JM;Epting CL;Thorp EB
可溶性MER （sMER）已成为心肌损伤后炎症延迟消退的潜在生物标志物，也是降低成人心脏相关发病率和死亡率的治疗靶点。然而，sMER在儿科人群中的重要性尚不清楚。我们试图研究sMER浓度是否随儿科患者心肌缺血再灌注（MI/R）损伤而改变。同时，我们还试图研究sMER浓度变化与特定患者、搭桥手术和术后数据之间的相关性。在一组儿科患者中，我们量化了每位患者体外循环前后血浆sMER浓度的变化。采用线性回归、相关系数和t检验比较先天性患者特征（即性别、年龄、心脏病变青紫与无青紫）、心脏搭桥数据（即心脏搭桥总时间、主动脉交叉夹总时间、围术期类固醇给药）和心脏搭桥后数据（术后呼吸机总天数、术后血管活性药物总天数和术后ICU总天数）与sMER浓度的变化。2019年4月至10月在一家三级儿童医院术中采集全血样本。我们的患者队列包括24名儿童患者，年龄从出生到19岁，同时患有紫绀型和无绀型心脏病变。回顾性分析小儿血液标本以及患者、旁路手术和术后资料。我们观察到17/24（71%）的患者在心脏搭桥后sMER浓度有统计学意义的增加。在儿科患者中，可溶MER浓度随着体外循环引起的炎症和心肌梗死/再灌注损伤而增加。sMER作为一种临床生物标志物，用于识别旁路诱发的心肌梗死/再灌注损伤术后预后恶化风险的儿科患者，需要进一步研究。
Soluble MER (sMER) has emerged as a potential biomarker for delayed resolution of inflammation after myocardial injury and a therapeutic target to reduce cardiac-related morbidity and mortality in adults. The significance of sMER in pediatric populations, however, is unclear. We sought to investigate if sMER concentrations change in response to myocardial ischemia and reperfusion (MI/R) injury in pediatric patients. In parallel, we also sought to investigate for correlations between the change in sMER concentration and specific patient, bypass, and post-operative data. We quantified the change in plasma sMER concentration post- compared to pre-cardiopulmonary bypass for each patient in a cohort of pediatric patients. Linear regression, correlation coefficients, and t-tests were used to compare innate patient characteristics (i.e. sex, age, cyanotic vs. acyanotic cardiac lesion), cardiac bypass data (i.e. total cardiac bypass time, total aortic cross-clamp time, peri-operative steroid administration), and post-cardiac bypass data (total post-operative ventilator days, total post-operative vasoactive medication days, and total post-operative ICU days) with change in sMER concentrations. Whole blood samples were obtained intra-operatively at a single tertiary care children’s hospital from April to October 2019. Our patient cohort included twenty-four pediatric patients ages ranging from birth to 19 years-old with both cyanotic and acyanotic cardiac lesions. Retrospective analyses of pediatric blood specimens as well as patient, bypass, and post-operative data were performed. We observed a statistically significant increase in sMER concentration post-cardiac bypass in 17/24 (71%) of patients. Soluble MER concentrations increase with cardiopulmonary bypass-induced inflammation and MI/R injury in pediatric patients. The utility of sMER as a clinical biomarker to identify pediatric patients at risk for exacerbated post-operative outcomes after bypass-induced MI/R injury requires further investigation.