Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations
Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations
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DOI：
10.1093/bja/83.4.602
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发表时间：
1999-10-01
影响因子：
9.8
通讯作者：
Lehot, JJ
中科院分区：
文献类型：
--
作者：
Aouifi, A;Piriou, V;Lehot, JJ
我们测量了36例心脏手术后患者的血清降钙素原（PCT）浓度，这些患者被分为三组：第1组，冠状动脉旁路移植术（CABG）与心肺转流（CPB）（n = 12）;第2组，CABG无CPB（n= 12）;第3组，瓣膜手术与CPB（n = 12）。术前、手术结束时和术后第8天每天测量血清PCT和C反应蛋白（CRP）浓度。血清PCT浓度升高，与心脏手术类型无关，第1天达到最大浓度：第1、2和3组的平均值分别为1.3（SD 1.8）、1.1（1.2）和1.4（1.2）ng ml（-1）（ns）。所有患者的血清PCT浓度均低于5 ng/ml。所有组的浓度在第5天恢复正常。确定全身炎症反应（SIRS）对血清PCT浓度的影响。在不考虑心脏手术类型的情况下，将患者事后分为SIRS患者（n = 19）和无SIRS患者（n = 17）。SIRS患者的血清PCT升高幅度明显更大（PCT峰值为1.79（1.64）ng ml（-1）vs无SIRS患者的0.34（0.32）ng ml（-1））（P = 0.005）。从其他10例术后并发症患者（循环衰竭n = 7;活动性心内膜炎n = 2;感染性休克n = 1）中获得PCT和CRP测量样本。在这些患者中，血清PCT浓度范围为6.2至230 ng ml（-1）。所有患者的血清CRP浓度均升高，组间无差异。术后CRP升高持续时间长于PCT。我们的结论是，SIRS诱导的心脏手术，有和没有CPB，影响血清PCT浓度与中度和短暂的术后高峰在术后第一天。术后血清PCT浓度超过5 ng/ml高度提示术后并发症。
We have measured serum procalcitonin (PCT) concentrations after cardiac surgery in 36 patients allocated to one of three groups: group 1, coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (n = 12); group 2, CABG without CPB (n= 12); and group 3, valvular surgery with CPB (n = 12). Serum PCT and C-reactive protein (CRP) concentrations were measured before operation, at the end of surgery and daily until postoperative day 8. Serum PCT concentrations increased, irrespective of the type of cardiac surgery, with maximum concentrations on day 1: mean 1.3 (SD 1.8), 1.1 (1.2) and 1.4 (1.2) ng ml(-1) in groups 1, 2 and 3, respectively (ns). Serum PCT concentrations remained less than 5 ng ml(-1) in all patients. Concentrations returned to normal by day 5 in all groups. To determine the effect of the systemic inflammatory response (SIRS) on serum PCT concentrations. patients were divided post hoc, without considering the type of cardiac surgery, into patients with SIRS (n = 19) and those without SIRS (n = 17). The increase in serum PCT was significantly greater in SIRS (peak PCT 1.79 (1.64) ng ml(-1) vs 0.34 (0.32) ng ml(-1) in patients without SIRS) (P = 0.005). Samples for PCT and CRP measurements were obtained from 10 other patients with postoperative complications (circulatory failure n = 7; active endocarditis n = 2; septic shock n = 1). In these patients, serum PCT concentrations ranged from 6.2 to 230 ng ml(-1). Serum CRP concentrations increased in all patients, with no differences between groups. The postoperative increase in CRP lasted longer than that of PCT. We conclude that SIRS induced by cardiac surgery, with and without CPB, influenced serum PCT concentrations with a moderate and transient postoperative peak on the first day after operation. A postoperative serum PCT concentration of more than 5 ng ml(-1) is highly suggestive of a postoperative complication.