Effect of off-pump and on-pump coronary artery bypass grafting on renal function

BACKGROUND: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) has the risk of renal dysfunction. The cause of renal dysfunction after CPB is multifactorial, such as nonpulsatile flow, renal hypoperfusion, hypothermia, and duration of CPB. This study compared off-pump technique with on-pump technique on renal function in patients who underwent CABG. METHODS: Sixty patients with normal preoperative renal functions undergoing CABG were randomly assigned to conventional revascularization with CPB (on-pump) or beating heart revascularization (off-pump). Renal functions were assessed up to 10 days postoperatively. RESULTS: Creatinine clearance was found to be significantly higher in the off-pump group than in the on-pump group (p<.05). The off-pump group had significantly less increase in creatinine levels when compared with the on-pump group (p<.05). The free water clearance values decreased similarly in both groups; however, the recovery was more prompt in the off-pump group (p<.05). No significant differences were found in the prevalence of postoperative hemodialysis. CONCLUSION: The off-pump technique may provide a positive contribution and sufficient protection on postoperative renal functions in patients undergoing CABG.     

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.     

Off-pump coronary artery bypass attenuates transient hepatocellular damage after myocardial revascularization

OBJECTIVE: Cardiopulmonary bypass (CPB) affects hepatocellular integrity and occasionally results in liver dysfunction after cardiac surgery. Performing coronary artery bypass graft surgery without CPB may help to reduce the risk of this complication and better preserve perioperative liver function. This study compared perioperative hepatocellular damage in patients undergoing on-pump and off-pump bypass surgery. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Patients scheduled for elective on-pump (n = 21) and off-pump (n = 17) coronary artery bypass surgery. MEASUREMENTS AND MAIN RESULTS: Liver function was assessed by serum levels of alcohol dehydrogenase (AD) and alpha-glutathione S-transferase (alpha-GST), which serve as more sensitive indices of hepatocellular injury than do conventional transaminases. Arterial blood was sampled at 6 stages: after induction of anesthesia (baseline); at the end of CPB in the on-pump group or on completion of the last distal anastomosis in the off-pump group; at the end of surgery; and 6 hours, 12 hours, and 24 hours after the end of anesthesia. The off-pump patients showed significantly lower increases in serum AD and alpha-GST levels than did the on-pump group. AD and alpha-GST values increased in the on-pump patients after the initiation of CPB and peaked at the end of surgery, with a return to baseline at 12 hours and 24 hours after the end of anesthesia. No clinically relevant liver dysfunction was observed in either group. CONCLUSIONS: CPB induced transient subclinical hepatocellular damage, whereas off-pump revascularization attenuated this damage.     

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.     

Endothelial apoptosis and circulating endothelial cells after bypass grafting with and without cardiopulmonary bypass.

OBJECTIVE: We compared profiles of the numbers of circulating endothelial cells (CEC) and the apoptosis-inducing capacity of serum samples on human endothelial cells (hEC) in on-pump and off-pump coronary artery bypass grafting (CABG) patients. METHODS: Blood samples from 30 patients undergoing CABG (randomly assigned to two groups: 15 patients off-pump and 15 on-pump (cardiopulmonary bypass, CPB)) were collected after induction of anesthesia (preoperatively), at weaning from CPB/end of bypass grafting (0 h), and 1, 6, 12, 24, and 48 h afterwards. CEC were isolated with immunomagnetic anti-CD146-coated Dynabeads, and counted in a Nageotte chamber. The apoptosis-inducing activity of serum samples on hEC was examined by a tissue culture assay system. Apoptotic and normal cells were identified using phase contrast/fluorescence microscopy after DNA dye staining. RESULTS: CEC numbers and proportions of apoptotic hEC were significantly elevated during and after surgery in both groups (p<0.01). Compared with the on-pump group, CEC and proportions of apoptotic hEC were significantly lower (p=0.04 and p=0.03, respectively) in patients having CABG performed off-pump. Starting at comparable baseline levels, the mean CEC-number was highest at 6h postoperatively with 81.9 ml(-1) (range, 44-141) for on-pump patients and 63.3 ml(-1) (range, 48-105) for off-pump patients. hEC apoptosis peaked also at T4: 16.5+/-2.8% versus 11.3+/-2.2%. In both groups, CEC numbers and proportions of endothelial apoptosis were still elevated at 48 h after surgery. CONCLUSION: The number of circulating endothelial cells and apoptotic endothelial cell death are markers of endothelial activation and damage during CABG. This study provides evidence that CABG with the use of CPB in comparison to OPCAB surgery is associated with a significantly more pronounced endothelial response in the immediate postoperative period.     

Activation of hemostasis after coronary artery bypass grafting with or without cardiopulmonary bypass

Activation of coagulation, fibrinolysis, and the vascular endothelium occurs after heart surgery with cardiopulmonary bypass (CPB), but the effects of eliminating CPB in patients undergoing coronary artery bypass grafting (CABG) are unknown. Therefore, we compared the hemostatic profiles of off-pump and on-pump CABG patients. Two groups of consecutive patients participating in a larger trial (the Octopus Trial) were randomly allocated to undergo CABG with (n = 20) or without (n = 20) CPB. Platelet numbers and plasma concentrations of P-selectin, prothrombin fragment 1.2 (F1.2), soluble fibrin, d-dimers, and von Willebrand factor (as a marker of endothelial cell activation) were measured and corrected for hemodilution. Compared with the on-pump CABG group, F1.2 and d-dimer levels were significantly lower (P = 0.004 and P = 0.03, respectively) in patients having CABG surgery performed off-pump. In the CPB group, F1.2 (median [interquartile range], 450% of baseline [233%-847%]) and d-dimer (538% [318%-1192%]) peaked in the immediate postoperative period and remained increased until Day 4, whereas in the off-pump group, F1.2 and d-dimer levels increased more gradually and peaked on Day 4 (342% [248%-515%] and 555% [387%-882%], respectively). In both groups, von Willebrand factor concentrations were increased until Day 4 (CPB, 308% [228%-405%]; off-pump, 288% [167%-334%]). Despite heparinization, CABG surgery with CPB was associated with excessive thrombin generation and fibrinolytic activity immediately after surgery. The off-pump group demonstrated a delayed postoperative response that became equal in magnitude to the CPB in the later (20-96 h) postoperative period.     

Peripheral tissue metabolism during off-pump versus on-pump coronary artery bypass graft surgery: the microdialysis study

Objective: The aim of this study was to monitor and compare metabolic changes in the skeletal muscle during coronary artery bypass grafting surgery with and without cardiopulmonary bypass (CPB) by means of interstitial microdialysis. Glucose, lactate, pyruvate and glycerol were assessed as markers of basic metabolism and tissue perfusion. Methods: Twenty patients undergoing surgical myocardial revascularization were enrolled in this pilot study. Ten patients were operated on without CPB (group A, off-pump) and 10 patients using normothermic CPB (group B, on-pump). Interstitial microdialysis was performed by a CMA 60 (CMA/Microdialysis AB, Sweden) probe, inserted into the patient's left deltoid muscle. Microdialysis measurements were performed at 30 min intervals. Glucose, lactate, pyruvate and glycerol were measured in samples using a CMA 600 Analyser (CMA/Microdialysis AB, Sweden). Results in both groups were statistically processed and the groups were compared. Results: Both groups were similar with regards to preoperative characteristics. Dynamic changes of interstitial concentrations of the measured analytes were found in off-pump (group A) and on-pump (group B) patients during the operation. There were no significant differences in dialysate concentrations of glucose and lactate between the groups. Significant differences were detected in pyruvate concentrations, lactate–pyruvate ratio and glycerol concentrations between off-pump versus on-pump patients. Pyruvate concentrations were higher in the off-pump group (p < 0.05), the lactate–pyruvate ratios indicating the aerobic/anaerobic metabolism status were lower in the off-pump group (p < 0.01) and the values of the concentrations of glycerol were lower in the off-pump group (p < 0.01). Conclusion: Dynamic changes in the interstitial concentrations of the glucose, glycerol, pyruvate and lactate were found in both groups of patients (off-pump and on-pump). The presented preliminary results suggest that extracorporeal circulation during cardiac operations could compromise skeletal muscle energy metabolism.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

前列腺癌患者外周血中巨噬细胞移动抑制因子基因-173位点单核苷酸多态性的研究

目的 探讨前列腺癌(PCa)患者外周血中巨噬细胞移动抑制因子(MIF)基因-173位点单核苷酸多态性在PCa发生中的作用.方法采用病例对照研究方法提取259例PCa、301例非肿瘤非前列腺疾病患者外周血中基因组DNA,应用PCR-限制性片段长度多态性分析MIF基因-173位点的多态性,比较不同基因型与PCa易感性的关系,并分析基因多态性与年龄、吸烟情况、肿瘤家族史的关系.结果 PCa患者中携带*C等位基因比例为36%,显著高于对照组的15%;携带MIF-173*C等位基因的个体PCa发病风险为G/G基因型的2.96倍(OR=2.96,95%CI:1.92～4.57);年龄>70岁、浅吸烟、有肿瘤家族史人群携带MIF-173*C等位基因的个体PCa发病风险显著高于G/G基因型个体,校正OR值分别为3.66(95%CI:2.02～6.62),2.83(95%CI:1.07～7.45)和3.26(95%CI:1.24～8.55).结论 MIF-173*C等位基因可能与PCa发生有关,年龄、吸烟情况、肿瘤家族史是PCa发病中的重要影响因素.     

A tumor necrosis factor gene polymorphism influences the inflammatory response after cardiac operation

BACKGROUND: The genetic background may influence cytokine release evoked by cardiac operation. Thus we determined the allele frequency and genotype distribution of a bi-allelic tumor necrosis factor (TNF) gene polymorphism and TNF-alpha concentrations in patients undergoing cardiac operations with and without cardiopulmonary bypass (CPB). METHODS: The TNF NcoI gene polymorphism was identified by polymerase chain reaction followed by restriction analysis of the polymerase chain reaction product. Reading the size of the resulting DNA bands from the agarose gel defined the genotype as homozygous or heterozygous for the two alleles TNFB1 and TNFB2. Blood samples to determine TNF-alpha plasma levels were drawn from the patients before induction of general anesthesia after termination of CPB or after finishing coronary revascularization on the beating heart in non-CPB patients and 12 hours postoperatively. RESULTS: The genotype distribution and allele frequencies in 47 patients undergoing cardiac operation with CPB were comparable with those found in 36 patients undergoing cardiac operation without CPB. The TNF-alpha plasma levels over time were comparable in patients with and without CPB. However, patients homozygous for the TNF-B2 allele had significantly higher TNF-alpha plasma levels after termination of the CPB (40.2 +/- 3.5 pg/mL; mean +/- standard error of the mean; n = 28) compared with non-CPB patients (29.8 +/- 2.5 pg/mL; mean +/- standard error of the mean; n = 15) (p < 0.05). CONCLUSIONS: Patients homozygous for the TNF-B2 allele showed significantly higher TNF-alpha plasma levels after termination of CPB compared with non-CPB patients. Therefore preoperative TNF genotyping may be useful as patients with genetically determined increased proinflammatory cytokine expression with multiple comorbidities may in particular benefit from avoiding the use of CPB.