IgA肾病患者外周血单个核细胞凋亡率及调控凋亡基因相关指标的检测

目的：探讨IgA肾病（IgAN）活动期与稳定期外周血单个核细胞（PBMC）凋亡率、CD3^＋、CD3^＋CD4^＋、CD3^＋CD8^＋、CD3^＋CD4^＋Fas、CD3^＋CD8^＋Fas、sFas、sFasL等表达的意义。方法：采用ELISA检测sFas、aFasL、IL-1β和流式细胞仪检测PBMC凋亡率等指标。结果：IgA肾病活动期患者PBMC凋亡率、sFas、sFasL明显高于正常人，稳定期sFas、sFasL较正常人有统计学差异（P〈0．01）；CD3^＋CD4^＋Fas、CD3^＋CD8^＋Fas升高（活动期，P〈0．05；稳定期，P〈0．01）；PBMC凋亡率与sFas、sFasL无相关性：sFasL与sFas、CD3^＋CD4^＋Fas、CD3^＋CD8^＋Fas有相关性。结论：IgAN活动期PBMC凋亡率明显高于正常人，导致sFas、sFasL增多，在IgAN中增加的sFas、sFasL可能抑制肾小球系膜细胞凋亡，而且可能是IgAN进展中的一个因素。     

改良超滤对体外循环后血浆可溶性细胞间黏附分子与肿瘤坏死因子α浓度变化的影响

目的探讨改良超滤在减轻体外循环（CPB）后炎症反应及内皮细胞损伤中的作用。方法将40例在CPB下行心脏直视手术的患者随机分为两组，超滤组（n=20）：在CPB后行改良超滤；对照组（n=20）：不进行改良超滤。两组患者分别于术前、CPB结束、术后4h和术后24h取静脉血，用酶联免疫吸附法测定血浆可溶性细胞间黏附分子-1（sICAM-1）和放射免疫法测定肿瘤坏死因子α（TNF—α）浓度，并进行比较。结果对照组患者术后4h和24h血浆sICAM-1浓度明显高于术前（P〈0．01）。术前和CPB结束时超滤组sICAM-1与对照组比较差异无统计学意义，术后4h和24h则明显低于对照组（269．6±33．8／μg／Lvs．409．6±37．3／μg／L，245．9±32．2／μg／Lvs．379．3±35．7μg／L；P〈0．01）。CPB结束时和术后4h超滤组TNF—α浓度明显高于术前（P〈0．01），但术后24h基本恢复至术前水平（0．177±0．024μg／Lvs．0．172±0．030μg／L；P〉0．05）。对照组CPB结束时TNF—α浓度明显高于术前（P〈0．01），术后4h和24h浓度有所下降，但仍较术前高（0．264±0．045μg／Lvs．0．174±0．033μg／L，0．218±0．028μg／Lvs．0．174±0．033μg／L；P〈0．05）。结论CPB可诱导炎症反应致内皮细胞损伤或激活，而改良超滤可明显减轻这些不良反应，有利于患者术后的恢复。     

高乌甲素对手术创伤病人应激反应的影响

目的观察高乌甲素（lappaconitine,LA）对手术创伤病人应激水平的影响,探讨其调控应激反应的可能机制。方法选择乳腺癌根治术、椎管狭窄减压术、股骨头坏死人工头置换术患者,共36例,按病种对等随机分3组,高乌甲素组（L）、曲马多组（T）、空白对照组（B）,每组12例。常规全凭静脉麻醉下实施手术,在L组、T组诱导前30min分别静脉滴注LA8mg、曲马多100mg,30min滴注完。诱导后即开始在L组、T组连接电子输注泵,以LA0．28mg／ml或曲马多8mg／ml进行持续背景输注,术后清醒后再实施PCA。B组术后按需肌肉注射哌替啶（50mg／次）和氟哌利多（2．5mg／次）镇痛。分别于麻醉用药前30min、术毕即刻、术后24h、术后48h采取外周静脉血,用放免法分别测定血浆内β-EP、ACTH、ALD水平,另份血样送检测血糖、白细胞分类计数及凝血四项（APTT、TT、PT、FIB）。结果T组在术毕即刻、术后24h,以及B组在术后各时点血浆β-EP升高与L组比较均有统计学差异（P〈0．05或P〈0．01）;T组、B组在术后各时点血浆ACTH水平升高与L组比较均有统计学差异（P〈0．05或P〈0．01）;T组在术毕即刻、B组在术后各时点血浆ALD水平升高与L组比较均有统计差异（P〈0．05）。B组在术毕即刻、术后24h血糖升高与L组比较差异有统计学意义（P〈0．05）。T组、B组在术后24h、术后48h体温较基础值升高（1．03±0．06）℃;B组中性粒细胞分类比率在术后48h升高与基础值及L组比较有统计学差异（P〈0．05）;T组在术后48h,B组在术后24h、术后48h单核细胞分类比率升高与基础值和L组比较有统计学差异（P〈0．05）：T组、B组在术后24h、术后48hAPTT缩短、B组在术后48hFIB增加与L组比较均有统计学差异（P〈0．05）。结论LA可以部分抑制手术创伤病人应激水平的增高,其机制可能与LA多种药理作用有关。     

神经外科患者术中控制性浅低温对炎性细胞因子平衡的影响

目的探讨神经外科患者术中控制性浅低温对炎性细胞因子平衡的影响。方法择期脑肿瘤切除术患者30例，ASAⅡ或Ⅲ级，年龄18～60岁，随机分为2组（n=15），常温组在术中控制中心温度为36.5℃，低温组在术中控制中心温度为34℃。分别在麻醉诱导前、术毕、术后24h时采集前臂静脉血5ml，测定血浆IL-1β、IL-6、TNF—α和IL-10的浓度和血常规，观察术后感染情况。结果与麻醉诱导前比较，2组术毕、术后24h时血浆IL-1β和IL-6浓度升高，白细胞、中性粒细胞、淋巴细胞和单核细胞的计数均升高，术后24h时血浆IL-10浓度升高（P〈0．01）；与常温组相比，低温组术毕、术后24h时血浆IL-1β和IL-6浓度降低（P〈0．05），血浆TNF-α、IL-10浓度和白细胞、中性粒细胞、淋巴细胞、单核细胞的计数差异无统计学意义（P〉0．05）。2组间术后感染率差异无统计学意义（P〉0．05）。结论神经外科患者术中控制性浅低温抑制促炎细胞因子的生成，对抗炎细胞因子无影响，导致炎性细胞因子失衡。     

体外循环心内直视手术期间乌司他丁对心肌缺血/再灌注损伤的保护作用

目的 评价乌司他丁对先天性心脏病心内直视手术围体外循环期心肌缺血／再灌注损伤的保护作用。方法 选择20例房间隔缺损或室间隔缺损修补术病人，随机分为对照组（C组）与乌司他丁组（U组），每组10例。分别于体外转流前（T1）、开放主动脉即刻（T2）、开放主动脉30min（T3）、停止CPB 4h(T4)和24h(T5)抽取动脉血，测定血浆CK－MB、CK活性及cTnI浓度。记录CPB转机时间、主动脉阻断时间、手术时间、围CPB期间心血管活性药物的使用情况、心脏复跳情况以及术后24h引流量。结果 两组病人术前血浆cTnI浓度及CK、CK－MB活性无关 正常范围内，组间比较无差异。C组血浆cTnI浓度在T3、T4和T5时点都显著升高（P＜0．01），于T4时点达峰值，T5时点开始下降。U组血浆cTnI浓度在T3、T4时点显著升高（P＜0．01），于T5时点已下降至正常水平。在T3－T5时点U组cTnI水平明显低于C组（P＜0．05）。C组与U组血浆CK和CK－MB活性在T2－T5时点都显著升高（P＜0．01），T2－T4时点两组比较无显著性差异，至T5时点U组显著低于C组（P＜0．05）。U组自动复跳率多于C组（P＜0．05）。术后24h引流量C组明显多于U组（P＜0．05）。结论 围CPB期间分两次使用乌司他丁1．2万U／kg，能减轻心肌缺血／再灌注损伤。     

体外循环对先天性心脏病合并肺动脉高压患者血浆一氧化氮、内皮素、肾上腺髓质素水平的影响

目的 探讨体外循环（CPB）对先天性心脏病合并肺动脉高压患者血浆一氧化氮（NO）、内皮素（ET）、肾上腺髓质素（ADM）水平的影响。方法 选择先天性心脏病拟在CPB下行心脏畸形矫正术患者36例,根据术前肺动脉收缩压（PASP）分为Ⅰ组（PASP＜30 mm Hg,n=8）、Ⅱ组（PASP 30～50 mm Hg,n=15）和Ⅲ组（PASP＞50 mm Hg,n=13）。分别于麻醉诱导前（基础值）、CPB即刻、CPB结束、CPB后3h、6h和24h采集桡动脉血,测定血浆NO、ET、ADM浓度。结果 Ⅱ组、Ⅲ组麻醉诱导前血浆ADM、ET、NO浓度高于Ⅰ组,其中ADM浓度随PASP的增高而升高（P＜0．05）,两者呈正相关（r= 0．858,P＜0．01）;与基础值相比,3组CPB后血浆ADM和ET浓度均增加,Ⅱ组、Ⅲ组CPB后NO浓度下降（P＜0．05）,Ⅰ组NO浓度变化无统计学意义（P＞0．05）。结论 ADM水平随PASP的增高而升高;CPB可引起先天性心脏病合并肺动脉高压患者血浆ET、ADM水平增高,NO水平降低。     

胸段硬膜外阻滞对心脏瓣膜置换术后病人血浆皮质醇、IFN-γ、IL-4的影响

目的 探讨胸段硬膜外阻滞对心脏辦膜置换术后病人血浆皮质醇（Cor）、干扰素-γ（IFN-γ）、白细胞介素-4（IL-4）的影响。方法 心脏辦膜置换术病人20例，心功能Ⅱ级或Ⅲ级，射血分数〉0．4，随机分为2组（n=10）：单纯全麻组（GA组）和全麻复合硬膜外阻滞组（GEA组）。采用视觉模拟评分法（VAS）评价术后的疼痛程度。于麻醉诱导前、术后4h和1、3、7d取外周血，测定血浆Cor、IFN-γ、IL-4的浓度。结果 血浆Cor浓度的比较：与麻醉诱导前比较，GA组术后4 h、1 d升高，GEA组术后4 h升高（P〈0．05）;与GA组比较，GEA组术后4 h、1 d降低（P〈0．05）。血浆IFN-γ浓度的比较：与麻醉诱导前比较，2组术后4 h和1、3 d均升高（P〈0．05）;与GA组比较，GEA组术后1 d升高（P 〈0．05）。血浆IL-4浓度的比较：与麻醉诱导前比较，GA组术后4 h降低（P〈0．05）。IFN-γ／IL-4比值的比较：与麻醉诱导前比较，2组术后4h、1d升高（P〈0．05）;与GA组比较，GEA组术后1d升高（P〈 0．05）。结论 胸段硬膜外阻滞可降低心脏辦膜置换术后病人血浆Cor水平，提高IFN-γ／IL-4比值。     

不停跳和心肺转流下冠状动脉搭桥术后呼吸动力学的变化

目的研究不停跳和心肺转流（CPB）下冠状动脉搭桥术对呼吸动力学的影响,并观察这些变化与时间的关系。方法择期行冠状动脉搭桥术的冠心病患者26例,根据是否应用CPB分成两组：CPB组（n=13）和不停跳冠状动脉搭桥组（OPC组,n=13）。在围术期用BICORECP-100呼吸功能监测仪监测胸肺顺应性、气道阻力、呼吸功等呼吸动力学指标的变化。结果两组的胸肺顺应性术后均出现降低,CPB组于术后3、6h较诱导后明显降低（P〈0．05或P〈0．01）,术后10h基本恢复至诱导后水平;而OPC组术后3h较诱导后明显下降（P〈0．05）,术后10h基本恢复。两组的气道阻力术后均出现增加,CPB组于术后6h高于诱导后水平（P〈0．05）,然后逐渐下降;OPC组于术后3h高于诱导后水平（P〈0．05）,术后10h基本恢复。两组的呼吸功均于术后3h明显增加（P〈0．05）,至术后10h后基本恢复。两组间呼吸动力学的比较差异均无统计学意义。两组患者术后呼吸支持时间相同。结论不停跳冠脉搭桥与CPB下冠脉搭桥术对术后呼吸动力学的改变相似,因此术后早期拔管也应谨慎。     

术后镇痛对冠心病患者心肌缺血的影响

目的通过观察冠心病患者术后血浆内皮素（ET-1）、一氧化氮（NO）、6-酮前列腺素F1α（6-Keto-PGF1α）浓度及血压的变化，探讨术后镇痛与心肌缺血的关系。方法胆囊结石合并冠心病患者40例，随机分为A、B两组，硬膜外麻醉复合气管插管全麻，术毕A组接电子镇痛泵，配方为0．125％布比卡因＋芬太尼0．01mg／kg＋格拉司琼3mg，行硬膜外自控镇痛（PCEA）；B组为空白对照组。分别于术前、术毕、术后24h抽静脉血测ET-1、NO、6-Keto-PGF1α血浆浓度。结果A组术后血压平稳，与术前比无明显变化。B组术后24h血压明显升高，收缩压（SBP）、舒张压（DBP）较术前分别升高了16．5％、15．9％。A组和B组ET-1浓度在术后24h较术前均有明显升高，但B组升高更明显（A组为29．2％，B组为77．0％，P〈0．01）；术后24hA组和B组NO浓度较术前分别降低了33．3％和60．0％，6-Keto-PGF1α浓度分别降低了20．3％和42．0％（P〈0．01）。A组术后出现心绞痛及心电图心肌缺血1例，B组6例。结论术后镇痛可减轻手术创伤及术后疼痛引起的舒缩血管物质分泌失衡状态，减少冠心病患者心肌缺血的发生率。     

选择性消化道去污染对体外循环患者内毒素血症及炎症介质的影响

目的探讨术前选择性消化道去污染（SDD）对体外循环（CPB）心内直视术患者肠源性内毒素血症、炎症介质和临床结果的影响。方法选择风湿性心脏病瓣膜置换术CPB患者30例，随机分为对照组与SDD组各15例。对照组行常规术前肠道准备，即饮食准备和清洁灌肠；SDD组在常规准备的基础上口服肠道不吸收抗生素等药物进行术前SDD干预。检测两组患者在诱导麻醉、CPB结束、CPB后2h、24h共4个时相点循环血D-乳酸、内毒素、TNF-α、补体C3值，临床生化指标和ICU停留时间、住院时间、术后机械通气时间、抗生素使用天数等临床指标。结果SDD组患者循环血D-乳酸水平在诱导麻醉和CPB后2h显著低于对照组（均P〈0．05）。两组患者CPB后体内内毒素水平皆显著增高（P〈0．05，P〈0．01），而SDD组在CPB结束及CPB结束24h内毒素水平皆显著低于对照组（P〈0．01，P〈0．05）。两组患者TNF-α水平比较，差异无显著性意义（均P〉0．05）；补体C3水平在CPB结束24h SDD组显著高于对照组（P〈0．05）；两组临床生化指标及结果比较，差异无显著性意义（均P〉0．05）。结论SDD干预是预防内毒素血症的有效肠道准备方法。     

外周血可溶性Fas蛋白及其配体、髓过氧化物酶水平对重症肺炎患儿预后不良的预测价值

目的观察重症肺炎患儿外周血可溶性Fas蛋白（sFas）、可溶性Fas蛋白配体（sFasL）和髓过氧化物酶（MPO）水平变化,并探讨三者对重症肺炎预后不良的预测价值。 方法选取四川中医药高等专科学校绵阳富临医院2016年2月至2020年5月收治的182例重症肺炎、196例轻症肺炎患儿和178例健康儿童,分别为重症组、轻症组和对照组;重症组患儿再根据预后分为预后不良组（29例）和预后良好组（153例）。采用单因素方差分析比较重症组、轻症组治疗前和对照组外周血sFas、sFasL和MPO水平;采用单因素和多因素Logistic回归分析重症组患儿预后不良的影响因素,采用受试者工作特征（ROC）曲线评价外周血sFas、sFasL和MPO水平以及联合指标预测重症组患儿预后不良的价值。 结果三组研究对象的性别、年龄和体重,重症组与轻症组患儿病原微生物分布、肺炎分期差异均无统计学意义（P均> 0.05）。重症组患儿治疗前外周血sFas、sFasL和MPO水平分别为（104.63 ± 19.75）ng/L、（1 062.36 ± 179.85）ng/L和（1 020.26 ± 59.71）U/L,轻症组患儿分别为（80.52 ± 13.66）ng/L、（703.57 ± 127.66）ng/L和（796.75 ± 43.02）U/L,对照组儿童分别为（58.78 ± 10.16）ng/L、（577.83 ± 121.22）ng/L和（632.59 ± 38.71）U/L;重症组和轻症组患儿以上3个指标水平均高于对照组（sFas：重症组 vs.对照组：t = 27.605、P < 0.001;轻症组vs.对照组：t = 17.322、P < 0.001;sFasL：重症组 vs.对照组：t = 29.908、P < 0.001,轻症组vs.对照组：t = 9.744、P < 0.001;MPO：重症组 vs.对照组：t = 71.920、P < 0.001;轻症组vs.对照组：t = 38.647、P < 0.001）,重症组患儿以上3个指标水平均显著高于轻症组（t = 13.885、22.488、41.973,P均< 0.001）。重症组患儿预后不良发生率为15.93%（29/182）。预后不良组患儿双重/多重感染占比（χ² = 12.081、P = 0.001）、多肺叶感染占比（χ² = 32.378、P < 0.001）和外周血白细胞计数（WBC）（t = 6.432、P < 0.001）、中性粒细胞百分比（N%）（t = 3.658、P = 0.001）、C-反应蛋白（CRP）（t = 19.415、P < 0.001）、降钙素原（PCT）（t = 26.101、P < 0.001）、sFas（t = 13.717、P < 0.001）、sFasL（t = 5.357、P < 0.001）和MPO（t = 5.435,P < 0.001）水平均显著高于预后良好组患儿;多因素Logistic回归分析显示以上指标均为重症组患儿预后不良的危险因素,差异均有统计学意义（OR = 5.969、95%CI：4.857~6.304、P = 0.029,OR = 7.485、95%CI：6.785~8.126、P = 0.014,OR = 5.332、95%CI：4.593~5.567、P = 0.010,OR = 4.959、95%CI：4.246~5.337、P = 0.015,OR = 5.143、95%CI：4.879~5.695、P = 0.003,OR = 6.126、95%CI：5.630~6.558、P = 0.008,OR = 8.325、95%CI：6.452~9.902、P = 0.005,OR = 8.469、95%CI：7.879~8.653、P = 0.001,OR = 9.132、95%CI：8.882~9.594,P = 0.003）。外周血sFas、sFasL和MPO水平预测重症组预后不良的Cut-off值分别为125.07 ng/L、1 171.21 ng/L和1 053.04 U/L;sFas、sFasL和MPO以及3个指标联合预测的曲线下面积（AUC）分别为0.875、0.890、0.897和0.955,3个指标联合预测AUC均显著高于sFas、sFasL、MPO水平单独预测,差异均有统计学意义（Z = 5.693、P = 0.005,Z = 5.192、P = 0.007,Z = 4.982、P = 0.009）。 结论重症肺炎患儿外周血sFas、sFasL和MPO水平均偏高,且在预后不良重症患儿中水平均更高,其联合应用可预测患儿不良预后。     

Examination of soluble Fas (sFas) and soluble Fas ligand (sFasL) in patients with burns

The FasL–Fas system is one of the recognized apoptosis-inducing systems, and has been determined to have important functions in relation to homeostasis and biological defense mechanisms. In this study, we investigated the serum levels of soluble Fas (sFas), soluble FasL (sFasL) and tumor necrosis factor (TNF-) in patients with burns. The sFas levels were found to be significantly higher in the patients who eventually died as compared to those in the patients who survived (3.9±1.8 ng/ml versus 2.6±1.0 ng/ml). On the other hand, the sFasL levels were significantly higher in the patients who survived (61.5±29.9 ng/ml versus 37.2±14.4 ng/ml) than in those who eventually died. A positive correlation was noted between the TNF- level and the sFas level, and a negative correlation was observed between the TNF- level and the sFasL level. These findings suggest that worsening of the condition of a burns patient may be related to changes in the Fas–FasL system.     

Transient rise in serum soluble Fas (APO-1/CD95) in patients undergoing cardiac surgery

The Fas molecule, also designated APO-1/CD95, belongs to the tumor necrosis factor (TNF) receptor family. It is a widely expressed membrane-anchored protein that induces apoptosis by Fas/Fas ligand (Fas-L) mediation. It was reported that Fas-mediated apoptosis plays an important role in regulation of the immune system, systemic inflammatory response, and ischemia/reperfusion injury. A soluble form of Fas (sFas) is produced either through the proteolytic cleavage of membrane-bound receptors or by alternative splicing, and sFas is thought to be implicated in apoptosis. In addition, sFas released damaged cells, and elevated serum levels of sFas reflect systemic tissue damage. To examine the specificity of sFas production during cardiac surgery with cardiopulmonary bypass, we serially measured the serum sFas levels in 13 patients during and after surgery. Blood samples were obtained before surgery, at the end of cardiopulmonary bypass, at the end of surgery, and at 12 h after surgery. Levels of serum sFas were determined by sandwich ELISA. Seven patients undergoing other types of surgeries served as controls. Although increased sFas was not observed in the control group, a significantly higher sFas level was detected in cardiac surgical patients at the end of surgery than before surgery (p = 0. 028), and the level decreased at 12 h after surgery. A significant correlation was observed between the maximum sFas values and the length of surgery (r = 0.659, p = 0.012) and cardioplegic arrest (r = 0.559, p = 0.046). Elevated serum sFas levels were observed in patients undergoing cardiac surgery, and these serum sFas levels reflect the severity of a surgery. sFas may play an important role in the pathophysiology of surgical damage caused by cardiac surgery with cardiopulmonary bypass.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

目的 研究小儿体外循环(cardiopulmonary bypass,CPB)中不同氧合器对中性粒细胞(PMN)凋亡的影响,为减轻体外循环伞身炎症反应提供新的思路.方法 将60例室间隔缺损患儿随机分为两组(n=30):西京-90鼓泡式氧合器组(B组)和希健-Ⅱ膜式氧合器组(M组).分别于CPB前、CPB结束时、CPB结束后4、8、24 h 5个时点采取静脉血,以伞血细胞计数仪测定PMN数量,流式细胞仪测定PMN凋亡率和PMN表面黏附分子CD11b表达变化,ELISA法测定血浆弹性蛋白酶浓度.结果 两组患者CPB结束后PMN凋亡率明显降低(P<0.05),PMN数量、CD11b表达、血浆弹性蛋白酶浓度明显升高(P<0.05),在CPB结束时及CPB结束后4、8 h PMN凋亡率M组均高于B组(P<0.05);而PMN数量、CD11b表达、血浆弹性蛋白酶水平B组均高于M组(P<0.05).CPB结束后24 h PMN数量B组高于M组(P<0.05).结论 与西京-90鼓泡氧合器相比,应用希健-Ⅱ膜式氧合器可以减轻CPB对PMN凋亡的抑制,进而减轻全身炎症反应.     

Inflammatory response after coronary revascularization with or without cardiopulmonary bypass

BACKGROUND: We sought to investigate the effect of multiple coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on the perioperative inflammatory response. METHODS: Sixty patients undergoing CABG were randomly assigned to one of two groups: (A) on pump with conventional CPB and cardioplegic arrest, and (B) off pump on the beating heart. Serum samples were collected for estimation of neutrophil elastase, interleukin 8 (IL-8), C3a, and C5a preoperatively and at 1, 4, 12, and 24 hours postoperatively. Furthermore, white blood cell (WBC), neutrophil, and monocyte counts were carried out preoperatively and at 1, 12, 36 and 60 hours postoperatively. Overall incidence of infection and perioperative clinical outcome were also recorded. RESULTS: The groups were similar in terms of age, weight, gender ratio, extent of coronary disease, left ventricular function, and number of grafts per patient. Neutrophil elastase concentration peaked early after CPB in the on-pump group, with a decline with time. Repeated-measures analysis of variance between groups and comparisons at each time point (modified Bonferroni) showed elastase concentrations were significantly higher in the on-pump than the off-pump group (both p < 0.0001). IL-8 increased significantly after surgery in the on-pump group, with no decline during the observation period (p = 0.01 vs off pump). C3a and C5a rose early after surgery in both groups when compared with baseline values. Postoperative WBC, neutrophil, and monocyte counts were significantly higher in the on-pump than the off-pump group (p < 0.01). Finally, the incidence of postoperative overall infections was significantly higher in the on-pump group (p < 0.0001 vs off pump). CONCLUSIONS: CABG on the beating heart is associated with a significant reduction in inflammatory response and postoperative infection when compared with conventional revascularization with CPB and cardioplegic arrest.     

Off-pump coronary artery bypass grafting attenuates proinflammatory markers

Objective: Cardiac surgery with cardiopulmonary bypass (CPB) has been considered the main causative factors of postoperative inflammatory reactions. The aim of this study was to compare surrogate markers of the proinflammatory response in patients who underwent coronary artery bypass grafting (CABG) with or without CPB. Methods and Results: Twenty patients undergoing first-time CABG were enrolled in the study, 10 with and 10 without CPB. Blood samples were drawn at the following times: at the anesthetic induction, the end of surgery, and thereafter at 12 and 24 hours postoperatively. Neutrophil elastase, interleukin (IL)-6 , and serum soluble Fas were chosen to evaluate the extent of the systemic inflammatory response. The groups were similar in terms of age, gender ratio, number of grafts per patient. There were no operative mortality or serious postoperative complications. Two of each group received blood transfusion postoperatively. Neutrophil elastase showed a significantly higher value in the on-pump group compared with the off-pump group at the end of surgery. Soluble Fas level showed a higher value at the end of surgery compared with baseline, while it had no significant changes in the off-pump patients. IL-6 levels in the on-pump group were consistently higher compared to the off-pump group but showed no statistically significant differences between the groups. Conclusion: Compared with off-pump CABG, on pump CABG induced higher serum levels of proinflammatory markers including neutrophil elastase and soluble Fas.     

Markers of inflammation and oxidative stress in patients undergoing CABG with CPB with and without ventilation of the lungs: a pilot study

Cardiopulmonary bypass triggers systemic inflammation and systemic oxidative stress. Recent reports suggest that continuous ventilation during cardiopulmonary bypass (CPB) can affect the outcome of patients after cardiac surgery. We investigated the influence of lung ventilation on inflammatory and oxidative stress markers during coronary artery bypass graft (CABG) with CPB in 13 patients with (Group 2) or without (Group 1) ventilation of the lungs with small tidal volume (4 ml/kg). IL-10 and elastase in blood were elevated in both groups with a peak at the end of CPB (P<0.05) and returned to the baseline at 24 h after surgery. A significant increase in Trolox Equivalent Antioxidant Capacity (TEAC) was observed in both groups (P<0.05). Glutathione peroxidase (GPx) was significantly elevated 24 h after surgery only in Group 1 (P<0.05). There was a significant decrease in alpha-tocopherol 24 h after surgery in both groups (P<0.05). The inflammatory response observed during CPB is not directly influenced by continuous ventilation of the lungs with small tidal volumes. The modulation of antioxidant defense systems by ventilation needs further investigation.     

Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response.

OBJECTIVE: In the present study the relationship was evaluated between perioperative inflammation and the postoperative acute phase response in patients undergoing elective coronary artery bypass grafting (CABG) assisted by cardiopulmonary bypass (CPB). CPB circuits contained either non-coated- (UMS), Carmeda- (BPS) or Trillium-coated oxygenators (BAS). METHODS: Prospectively, 71 CABG patients were randomly allocated to one of the oxygenator groups (UMS: n=25, BPS: n=25 and BAS: n=21). Terminal complement complexes (TCC) and elastase were determined in plasma samples collected before, during and after bypass. Secretory phospholipase A2 (sPLA2) and C-reactive protein (CRP) were determined before and after bypass. RESULTS: Demographic, CPB and clinical outcome data were similar for the three groups. TCC and elastase increased during CPB, and decreased thereafter. Significant differences between the groups were present in the levels of TCC at the end of CPB (P=0.002) and at the first (P=0.012) and second (P<0.001) postoperative days, the BPS and BAS groups having reduced levels of TCC compared to the UMS group. Also elastase concentrations differed significantly between the groups at the end of CPB (P<0.001). The postoperative sPLA2 and CRP levels increased in all three groups on the first and second postoperative days, but no significant differences were present between the groups. CONCLUSIONS: Material-induced reduction of the inflammatory response during CPB does not affect the postoperative acute phase response. Thus, in CABG patients this response seems relatively unaffected by the composition and/or biocompatibility of the modern CPB circuit and rather to be evoked by surgical trauma, anesthetics and organ perfusion.     

梗阻性黄疸大鼠可溶性Fas与肝肾功能改变的关系

目的:探讨可溶性Fas(sFas)与梗阻性黄疸大鼠肝肾功能损害的关系.方法: 将雄性SD大鼠36只随机分为对照组(A组)、胆总管结扎节第7天组(B组)和第21天组(C组 ),每组12只.分别检测各组血清胆红素、ALT、白蛋白、肌酐、尿素氮和sFas.光镜观察肝肾组织的病理改变. 结果B组胆红素、ALT和sFas较A组显著升高(P<0.01 );C组胆红素、ALT、肌酐、尿素氮和sFas较A组显著升高(P<0.01).B组和C组部分肝细胞和肾小管上皮细胞肿胀和坏死,C组较严重. 结论sFas与梗阻性黄疸大鼠肝肾功能损害相关,可能通过细胞凋亡起作用 .