Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease.
Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease.
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DOI：
10.1097/ccm.0000000000000982
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发表时间：
2015-07
影响因子：
8.8
通讯作者：
Pathan N
中科院分区：
文献类型：
--
作者：
Correia GD;Wooi Ng K;Wijeyesekera A;Gala-Peralta S;Williams R;MacCarthy-Morrogh S;Jiménez B;Inwald D;Macrae D;Frost G;Holmes E;Pathan N
补充数字内容可在文本中找到。炎症和新陈代谢是紧密相连的。两者在先天性心脏病手术后都会出现明显的失调，导致器官衰竭和发病率。在这项研究中，我们将细胞因子和代谢谱结合起来，研究了与传统血糖管理相比，术后严格血糖控制对先天性心脏手术儿童代谢和炎症结局的影响。目的是评估先天性心脏手术后关键代谢物的变化，并根据预期的临床结果检查代谢谱对患者分层的潜力。实验室和临床研究。大学医院和实验室。在28名接受先天性心脏病手术的儿童中，15名术后接受严格的血糖控制，13名接受常规治疗。采用质子核磁共振波谱法对血浆进行代谢谱分析。使用曲线拟合算法测量一组代谢物。采用酶联免疫吸附法测定炎症因子。根据疾病严重程度的临床指标（风险调整先天性心脏手术评分-1分、儿科Logistic器官功能障碍、肌力评分、通气持续时间和儿童无icu天数）对数据进行评估。与术前状态相比，从手术到恢复的这段时间内，代谢和炎症谱发生了变化。严格的血糖控制并没有显著改变反应谱。我们确定了与手术和疾病严重程度相关的8种代谢物（3-羟基丁酸盐、丙酮、乙酰乙酸盐、柠檬酸盐、乳酸盐、肌酸、肌酐和丙氨酸）。促炎反应的强度，特别是白细胞介素-8和白细胞介素-6浓度，与28天无picu天数呈负相关。白细胞介素-6/白细胞介素-10比值与血浆乳酸水平直接相关。这是关于儿童心脏手术后代谢反应的第一篇报道。利用核磁共振监测患者的过程，我们确定了代谢物的浓度和轨迹似乎与临床结果相关。代谢谱分析可用于患者分层和指导临床干预调查。
Supplemental Digital Content is available in the text. Inflammation and metabolism are closely interlinked. Both undergo significant dysregulation following surgery for congenital heart disease, contributing to organ failure and morbidity. In this study, we combined cytokine and metabolic profiling to examine the effect of postoperative tight glycemic control compared with conventional blood glucose management on metabolic and inflammatory outcomes in children undergoing congenital heart surgery. The aim was to evaluate changes in key metabolites following congenital heart surgery and to examine the potential of metabolic profiling for stratifying patients in terms of expected clinical outcomes. Laboratory and clinical study. University Hospital and Laboratory. Of 28 children undergoing surgery for congenital heart disease, 15 underwent tight glycemic control postoperatively and 13 were treated conventionally. Metabolic profiling of blood plasma was undertaken using proton nuclear magnetic resonance spectroscopy. A panel of metabolites was measured using a curve-fitting algorithm. Inflammatory cytokines were measured by enzyme-linked immunosorbent assay. The data were assessed with respect to clinical markers of disease severity (Risk Adjusted Congenital heart surgery score-1, Pediatric Logistic Organ Dysfunction, inotrope score, duration of ventilation and pediatric ICU-free days). Changes in metabolic and inflammatory profiles were seen over the time course from surgery to recovery, compared with the preoperative state. Tight glycemic control did not significantly alter the response profile. We identified eight metabolites (3-d-hydroxybutyrate, acetone, acetoacetate, citrate, lactate, creatine, creatinine, and alanine) associated with surgical and disease severity. The strength of proinflammatory response, particularly interleukin-8 and interleukin-6 concentrations, inversely correlated with PICU-free days at 28 days. The interleukin-6/interleukin-10 ratio directly correlated with plasma lactate. This is the first report on the metabolic response to cardiac surgery in children. Using nuclear magnetic resonance to monitor the patient journey, we identified metabolites whose concentrations and trajectory appeared to be associated with clinical outcome. Metabolic profiling could be useful for patient stratification and directing investigations of clinical interventions.