Perioperative kinetics of endocan in patients undergoing cardiac surgery with and without cardiopulmonary bypass
Perioperative kinetics of endocan in patients undergoing cardiac surgery with and without cardiopulmonary bypass
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DOI：
10.1016/j.cyto.2016.03.006
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发表时间：
2016-07-01
期刊：
影响因子：
3.8
通讯作者：
Sharma, Vivek
中科院分区：
文献类型：
--
作者：
Madhivathanan, Pradeep R.;Fletcher, Nick;Sharma, Vivek
简介：内皮细胞特异性分子-1（Endothelial Specific Molecule-1，Endocan）是一种新型的生物标志物，与创伤等全身炎症状态引起的急性肺损伤（Acute Lung Injury，ALI）的发生有关。急性呼吸窘迫综合征（ARDS）是一种严重形式的ALI，是心脏手术后由于手术期间使用心肺转流（CPB）等风险因素而可能发生的毁灭性并发症。在这项研究中，我们研究的动力学endocan在围手术期的心脏surgery patients.Methods：伦理批准后，我们获得了知情同意，从21例接受择期心脏手术（3组，每组7例：冠状动脉旁路移植术（CABG）与使用CPB，非体外循环CABG和复杂的心脏手术）。在围手术期采集用于内皮素水平的系列血液样本（T0：诱导前基线，T1：肝素给药时，T2：鱼精蛋白给药时，T2、T3、T4和T5分别在鱼精蛋白给药后1、2、4和6 h）。使用酶联免疫吸附测定（ELISA）方法分析内毒素样品。统计分析纳入了使用的测试normality.Results：我们的研究结果表明，初始上升的血清内皮素水平从基线在所有患者麻醉诱导后。接受非体外循环手术的患者在围手术期内的内皮素浓度低于接受CPB的患者。与CPB分离后，内皮素水平降低，这可能归因于CPB后的血液稀释。在给予鱼精蛋白后，所有患者的内聚糖浓度稳定增加，在2至6小时之间达到稳态。结论：高血压合并严重冠状动脉狭窄患者血浆内皮素水平明显升高，高血压合并严重冠状动脉狭窄患者血浆内皮素水平明显升高。内皮聚糖浓度在麻醉诱导后增加，并在与CPB分离后4小时降低。全身炎症可能是CPB后内皮素水平升高的原因。(C)2016爱思唯尔有限公司版权所有
Introduction: Endothelial Specific Molecule-1 or endocan is a novel biomarker associated with the development of acute lung injury (ALI) in response to a systemic inflammatory state such as trauma. Acute Respiratory Distress syndrome (ARDS), a severe form of ALI is a devastating complication that can occur following cardiac surgery due to risk factors such as the use of cardiopulmonary bypass (CPB) during surgery. In this study we examine the kinetics of endocan in the perioperative period in cardiac surgical patients.Methods: After ethics approval, we obtained informed consent from 21 patients undergoing elective cardiac surgery (3 groups with seven patients in each group: coronary artery bypass grafting (CABG) with the use of CPB, off-pump CABG and complex cardiac surgery). Serial blood samples for endocan levels were taken in the perioperative period (T0: baseline prior to induction, T1: at the time of heparin administration, T2: at the time of protamine, T2, T3, T4 and T5 at 1, 2, 4 and 6 h following protamine administration respectively). Endocan samples were analysed using the enzyme-linked immunosorbent assay (ELISA) method. Statistical analysis incorporated the use of test for normality.Results: Our results reveal that an initial rise in the levels of serum endocan from baseline in all patients after induction of anaesthesia. Patients undergoing off-pump surgery have lower endocan concentrations in the perioperative period than those undergoing CPB. Endocan levels decrease following separation from CPB, which may be attributed to haemodilution following CPB. Following administration of protamine, endocan concentrations steadily increased in all patients, reaching a steady state between 2 and 6 h. The baseline endocan concentrations were elevated in patients with hypertension and severe coronary artery disease.Conclusion: Baseline endocan concentrations are higher in hypertensive patients with critical coronary artery stenosis. Endocan concentrations increased after induction of anaesthesia and decreased four hours after separation from CPB. Systemic inflammation may be responsible for the rise in endocan levels following CPB. (C) 2016 Elsevier Ltd. All rights reserved.