CAJ | 학술논문

目的动态观察婴幼儿体外循环(CPB)围术期血浆中S100A12和可溶性晚期糖基化终末产物受体(sRAGE)水平变化,探讨其在婴幼儿CPB术后非感染性肺部并发症(NPC)早期预测中的作用.方法采用病例对照研究.选取2011年6月1日至7月31日,在浙江大学附属儿童医院行CPB下心内直视矫治术、年龄＜3岁的先天性心脏病患儿.排除术前肺部有炎症性疾病和肝肾功能异常的患儿.根据术后是否出现胸腔积液、乳糜胸、部分肺不张、肺动脉高压危象、气道紊乱、气胸、纵膈积气、膈神经麻痹,20例被分为NPC组,40例被分为no-NPC组.于手术前,CPB前,CPB后,手术后1、12和24 h,采用ELISA法检测血浆中S100A12和sRAGE浓度.两组之间的浓度差异采用t检验；多因素Logistic回归分析检验S100A12和sRAGE在术后NPC早期预测中的作用,并以优势比(OR)及95％可信区间(95％ CI)表示相对危险度；以P＜0.05为差异具有统计学意义.结果血浆中S100A12和sRAGE浓度在CPB后立刻明显升高(P＜0.01).术后24h后血浆中sRAGE水平明显低于术前水(P＜0.05),而S100A12仍明显高于术前水平(P＜0.01).CPB术后即刻,NPC组血浆中S100A12和sRAGE水平明显高于no-NPC组(P＜0.05).术后24 hNPC组血浆中S100A12水平仍明显高于no-NPC组(P＜0.05),而两组患儿血浆中sRAGE水平无明显差异(P＞0.05).逐步法Logistic回归分析,CPB后即刻血浆中S100A12水平与术后NPC的发生明显相关(OR=1.042,95％ CI:1.010～ 1.076,P=0.011).CPB后即刻血浆中S100A12与术后机械通气时间(r=0.47,P＜0.01)、住ICU时间(r=0.363,P=0.008)和住院时间(r =0.402,P=0.002)明显相关.结论婴幼儿CPB术后血浆中S100A12和sRAGE水平立刻明显升高.血浆中S100A12是婴幼儿CPB术后NPC发生和预后的早期预测指标.
목적 동태관찰영유인체외순배(CPB)위술기혈장중S100A12화가용성만기당기화종말산물수체(sRAGE)수평변화,탐토기재영유인CPB술후비감염성폐부병발증(NPC)조기예측중적작용.방법 채용병례대조연구.선취2011년6월1일지7월31일,재절강대학부속인동의원행CPB하심내직시교치술、년령＜3세적선천성심장병환인.배제술전폐부유염증성질병화간신공능이상적환인.근거술후시부출현흉강적액、유미흉、부분폐불장、폐동맥고압위상、기도문란、기흉、종격적기、격신경마비,20례피분위NPC조,40례피분위no-NPC조.우수술전,CPB전,CPB후,수술후1、12화24 h,채용ELISA법검측혈장중S100A12화sRAGE농도.량조지간적농도차이채용t검험；다인소Logistic회귀분석검험S100A12화sRAGE재술후NPC조기예측중적작용,병이우세비(OR)급95％가신구간(95％ CI)표시상대위험도；이P＜0.05위차이구유통계학의의.결과 혈장중S100A12화sRAGE농도재CPB후립각명현승고(P＜0.01).술후24h후혈장중sRAGE수평명현저우술전수(P＜0.05),이S100A12잉명현고우술전수평(P＜0.01).CPB술후즉각,NPC조혈장중S100A12화sRAGE수평명현고우no-NPC조(P＜0.05).술후24 hNPC조혈장중S100A12수평잉명현고우no-NPC조(P＜0.05),이량조환인혈장중sRAGE수평무명현차이(P＞0.05).축보법Logistic회귀분석,CPB후즉각혈장중S100A12수평여술후NPC적발생명현상관(OR=1.042,95％ CI:1.010～ 1.076,P=0.011).CPB후즉각혈장중S100A12여술후궤계통기시간(r=0.47,P＜0.01)、주ICU시간(r=0.363,P=0.008)화주원시간(r =0.402,P=0.002)명현상관.결론 영유인CPB술후혈장중S100A12화sRAGE수평립각명현승고.혈장중S100A12시영유인CPB술후NPC발생화예후적조기예측지표.
Objective To examine the kinetics of plasma S100A12 and soluble receptor for advanced glycation end products (sRAGE) in infants and young children undergoing cardiopulmonary bypass ( CPB),and to investigate whether they could protective the occurrence of noninfectious pulmonary complication (NPC) after cardiac surgery.Methods This was a case-control study.The subjects included all children aged ＜3 years old who underwent cardiac surgery with CPB during the period from June 1st to July 31st 2011.The patient who showed pulmonary inflammation or had abnormal liver or renal function before surgery was excluded.The remain patients were divided into 2 groups according to whether they had developed NPC postoperatively.Twenty patients were grouped into NPC because they developed the complications of pleural effusion,chylothorax,partial lung collapse,pulmonary hypertensive crisis,airway disorders,pneumothorax,pneumomediastinum,or phrenic nerve palsy.Forty patients were categorized into the no-NPC group.Plasma concentrations of S100A12 and sRAGE were measured using ELISA at baseline,before CPB,immediately after CPB,1 h,12 h and 24 h after operation.Differences concentrations between two groups were analyzed with t test.A stepwise logistic regression analysis was used to indentify the independent risk factor for NPC.A P value ＜0.05 was considered statistically significant.Results Plasma levels of S100A12 and sRAGE dramatically increased immediately after CPB ( P ＜ 0.01 ).The levels of sRAGE dropped to lower than baseline level (P ＜0.05),while S100A12 was still at high level 24h after operation (P ＜0.01 ).Levels of S100A12 and sRAGE immediately after CPB in NPC group were significantly higher than the no-NPC group (P ＜ 0.05).Twenty-four hours after operation,levels of S100A12 were still higher in NPC group than no-NPC (P ＜ 0.01 ),while levels of sRAGE were similar in the two groups ( P ＞ 0.05 ).In the stepwise logistic regression analysis,plasma S100A12 level immediately after CPB remained as a independently predictor for postoperative NPC (OR =1.042,95％ CI:1.010 ～ 1.076,P =0.011 ).Levels of S100A12 immediately after CPB were positively associated with mechanical ventilation time ( r =0.47,P ＜ 0.01 ),duration of surgical Intensive Care Unit ( r =0.407,P =0.002) and hospital stay ( r =0.421,P =0.01 ).Conclusions Plasma levels of S100A12 and sRAGE were significantly increased immediately after CPB and the elevated plasma S100A12 immediately after CPB served as an early reliable biomarker of the occurrence and the prognosis of NPC after CPB in infants and young children.