前列腺按摩液中IL-8和TNF-α测定在慢性前列腺炎诊断、分型中的临床意义

目的 :探讨检测前列腺按摩液 (EPS)中细胞因子白细胞介素 8(IL 8)和肿瘤坏死因子α(TNF α)在慢性前列腺炎诊断、分型中的意义。　方法 :ELISA法检测 78例临床诊断的慢性前列腺炎患者 [其中慢性前列腺炎(CBP)组 12例 ,慢性非细菌性前列腺炎 /慢性骨盆疼痛综合征 (CPPS)ⅢA组 38例 ,CPPSⅢB组 2 8例 ]和 12例正常对照者EPS中IL 8和TNF α浓度。分析各组EPS中IL 8和TNF α浓度差异。　结果 :CBP组和CPPSⅢA组EPS中IL 8水平 [(10 96 7.5± 3477.7) pg/ml;(92 6 8.4± 2 0 34.6 ) pg/ml]和TNF α水平 [(84 .1± 5 4 .7) pg/ml;(32 .6± 18.6 ) pg/ml]显著高于CPPSⅢB组和正常对照组EPS中的IL 8水平 [(2 72 6 .1± 2 77.5 ) pg/ml;(2 80 0 .0± 32 0 .2 )pg/ml]和TNF α水平 [(12 .6± 7.1)pg/ml;(12 .9± 10 .1)pg/ml](P均 <0 .0 1)。　结论 :检测EPS中IL 8、TNF α水平可能有助于CBP、慢性非细菌性前列腺炎 /慢性骨盆疼痛综合征的分型诊断。     

肿瘤坏死因子α基因启动子多态性与肾移植术后急性排斥反应的关系

目的　探讨肿瘤坏死因子α(TNF α)基因启动子 3 0 8位多态性在预测肾移植术后急性排斥反应中的意义。　方法　酶联免疫吸附试验检测 3 5例肾移植患者术前外周血细胞分泌的TNF α水平 ,应用限制性片段长度多态性 (PCR RFLP)方法检测TNF α基因启动子 3 0 8位多态性 ,分析其与术后急性排斥反应的关系。　结果　TNF α启动子 3 0 8位为A/A、A/G基因型者TNF α水平分别为(62 4.96± 177.78)pg/ml、(5 44 .3 2± 13 2 .42 )pg/ml,明显高于G/G基因型者的 (2 3 3 .16± 2 5 .3 7)pg/ml,P<0 .0 1。在HLA DR错配情况下 ,TNF α高分泌基因型受者有 5例 (5 0 % )术后发生急性排斥反应 ,而低分泌基因型受者仅有 2例 (8% )发生急性排斥反应 (P =0 .0 12 )。　结论　肾移植受者TNF α基因启动子 3 0 8位多态性与体外细胞因子产生水平有关 ,TNF α高分泌基因型是术后 3个月内发生急性排斥反应的高危因素     

精浆肿瘤坏死因子α和表皮生长因子测定的意义

本文用酶联免疫法测定正常对照、慢性前列腺炎及输精管结扎者 (VSM )精浆中TNF α和EGF含量。结果发现精浆EGF浓度在VSM组、正常对照组及慢性前列腺炎组中呈递增趋势 (1188.77± 10 8.89pg/ml,12 0 7.2 5± 12 5 .5 3pg/ml,12 2 9.2 5± 73.88pg/ml) ,但无统计学意义。精浆中TNF α浓度在VSM组和正常对照组(6 .2 3± 2 .75 pg/ml,6 .87± 2 .5 7pg/ml)明显低于慢性前列腺炎组 (17.31± 8.0 8pg/ml)。提示对精浆中TNF α测定有望成为临床上对慢性前列腺炎评价的指标     

血清淀粉样蛋白A:检测膀胱炎全身炎症反应的一个全新血清学指标

作者比较了血清淀粉样蛋白A(SAA)、C反应蛋白 (CRP)、白介素 6(IL 6 )和肿瘤坏死因子 (TNF α)作为肾盂肾炎和膀胱炎炎症反应指标的诊断价值。本组研究包括 37名急性肾盂肾炎患者和 32名急性膀胱炎患者 ,收集 6 9名患者的血清标本测定其SAA、CRP、IL 6和TNF α水平 ,健康人群作为阴性对照。结果发现 ,肾盂肾炎患者的血清SAA(P <0 .0 0 1)、CRP(P <0 .0 0 1)、IL 6(P <0 .0 0 1)和TNF α值 (P <0 .0 1)均比膀胱炎患者显著升高。在鉴别肾盂肾炎和膀胱炎时 ,SAA、CRP、IL 6和TNF α的特异性分别为 96 %、94 %、85 %和91% …     

高纯度透析浓缩液对血液透析患者血清白细胞介素6、肿瘤坏死因子α和白蛋白水平的影响

目的比较高纯度透析浓缩液和普通透析浓缩液对长期透析患者血清促炎症因子白细胞介素(6IL鄄6)、肿瘤坏死因子α(TNF鄄α)和血清白蛋白的影响。方法采用前瞻性临床对照研究,将85例维持性血液透析患者随机分为两组,分别采用普通透析浓缩液(常规组,例)和42高纯度透析浓缩液(高纯度组,例)进行常规低通量血液透析治疗并随访4312个。月比较常规组与高纯度组患者在血清IL鄄6、TNF鄄α、血清白蛋白、干体重、体重指数(BMI)、上臂中肌肉周径(MAC)、血红蛋白、红细胞压积、白细胞计数、中性粒细胞计数以及红细胞生成素应用剂量上的差异。结果高纯度组43例,常规组42例,两组患者间年龄、性别比例、透析龄、BMI、Kt/V值和血清IL鄄6、TNF鄄α水平差异无统计学意义。与基础水平比较,随访结束时高纯度组患者血清IL鄄6[(6.91±5.13)pg/ml比(3.06±2.42)pg/ml]和TNF鄄α水平[(14.78±4.61)pg/ml比(13.60±4.24)pg/ml]显著下降;血清白蛋白[(35.9±3.7)g/L比(37.6±3.4)g/L]、血红蛋白[(82.4±24.7)g/L比(88.2±22.9)g/L]及红细胞压积(0.25±0.07比0.28±0.05)均显著上升。与常规组比较,随访结束时高纯度组血清IL鄄6[(3.06±2.42)pg/ml比(4.22±3.99)pg/ml]和TNF鄄α水平[(13.60±4.24)pg/ml比(15.79±6.38)pg/ml均显著下降     

急性胰腺炎时促炎症因子和抗炎症因子的变化及其意义

目的研究急性胰腺炎全身炎性反应综合征 (systemicinflammatoryresponsesyndrome,SIRS)时促炎因子和抗炎因子的变化及其意义。方法本组 32例急性胰腺炎患者中轻症急性胰腺炎 (mildacutepancreatitis,MAP) 13例 ,重症急性胰腺炎 (severeacutepancreatitis,SAP) 19例。观察入院后第 1、3、5、7日急性生理和既往健康评分 (APACHEⅡ )、BalthazarCT评分、血清白细胞介素 (IL) 6、IL 8、IL 10和IL 12的变化。结果入院第 1日MAP组APACHEⅡ评分和BalthazarCT评分分别为(5 6± 2 1)和 (1 5± 0 6 ) ,SAP组为 (13 6± 4 3)和 (6 3± 1 5 ) ,2组APACHEⅡ评分和BalthazarCT评分的差异均有显著意义 (P值均 <0 0 1) ;入院第 1日MAP组患者血清IL 6、IL 8、IL 10、IL 12的水平分别为 (9± 3)pg/ml、(4 1± 16 )pg/ml、(7 9± 2 3)pg/ml、(12 9± 30 )pg/ml,SAP组分别为 (6 4± 14)pg/ml、(5 1± 18)pg/ml、(6 9± 1 7)pg/ml、(6 4± 14)pg/ml,2组IL 10 /IL 6、IL 12 /IL 6、IL 12 /IL 8的比值差异有显著意义 (P值均 <0 0 1)。结论IL 6、IL 8和IL 10、IL 12的表达水平与急性胰腺炎的严重度有关 ,综合BalthazarCT评分、APACHEⅡ评分和血清中促炎因子和抗炎因子的比值对急性胰腺炎的严重度进行评估更准确     

肝癌合并肝硬化患者肝癌切除后机体免疫状态的变化

目的探讨肝癌合并肝硬化患者癌灶切除前后机体免疫状态的变化。方法以肝硬化患者为对照组 ,采用流式细胞技术 (FCM)及ELISA方法分析 18例中晚期肝癌合并肝硬化患者癌灶切除前后外周血T细胞亚群CD4、CD8、CD4 /CD8及Th1/Th2细胞因子IFN γ、IL2、IL10蛋白水平的变化。结果　肝癌切除术后CD4 (33± 3) %、CD4 /CD8(1 1± 0 1)、IL2 (71± 11)pg/ml、IFN γ(90± 15 )pg/ml回升 ,高于术前水平〔CD4 (2 9± 4 ) %、CD4 /CD8(0 9± 0 3)、IL2 (5 7± 15 )pg/ml、IFN γ(78± 13)pg/ml〕 ,但仍低于肝硬化组〔CD4 (37± 4 ) %、CD4 /CD8(1 3± 0 2 )、IL2 (82± 15 )pg/ml、IFN γ(10 4± 2 2 )pg/ml〕(P <0 0 1或P <0 0 5 ) ;CD8(32± 3) %、IL10 (70± 9)pg/ml下降 ,低于术前〔CD8(35± 6 ) %、IL10(81± 15 )pg/ml〕水平但高于肝硬化组〔CD8(2 9± 2 ) %、IL10 (6 1± 10 )pg/ml〕(P <0 0 5 )。结论　癌灶切除后 ,机体免疫功能有明显改善。但仍未恢复到肝硬化患者的水平。     

急性梗阻性化脓性胆管炎患者血清白细胞介素-10的检测及意义

检测急性梗阻性化脓性胆管炎 (AOSC)患者血清中白细胞介素 - 10 (IL - 10 ) ,并探讨 IL - 10在 AOSC发病中的意义。方法　 46例 AOSC和 2 0例健康人血清 IL - 10的测定采用双抗体夹心 EL ISA检测法。结果　 AOSC患者入院时、术后第 1、6、12 d血清 IL - 10浓度分别为 35 6 .9± 31.6 pg/ml、2 98.5± 2 7.4pg/m l、192 .4± 2 6 .1pg/ml、10 6 .3± 2 4.2 pg/ml,健康人血清 IL - 10浓度为 92 .5± 2 1.6 pg/ml。与健康人比较 ,AOSC患者入院时血清 IL - 10明显升高 (P<0 .0 1) ,术后第 1、6、12 d逐渐下降至正常。结论　 IL - 10参与 AOSC的病理过程 ,血清 IL - 10增加是机体的一种防御反应     

肝细胞癌合并肝硬化患者肝脾联合切除术后免疫功能变化的研究

目的　探讨肝细胞癌合并肝硬化患者肝癌切除时联合脾切除术后免疫功能的变化。方法　将 16例肝癌合并肝硬化患者分成 2组 ,即肝癌切除联合脾切除组 ( 7例 )和单纯肝癌切除组 ( 9例 ) ,于术前、术后 2个月取外周血 7ml,采用流式细胞仪检测CD4、CD8、CD4 /CD8,ELISA法检测IL 2、IFN γ、IL 10。　结果　 2组患者术前CD4、CD8、CD4 /CD8、IL 2、IFN γ、IL 10水平差异无显著性 ;术后 2个月 ,切脾组CD4 ( 3 8 2 %± 3 7% )、CD4 /CD8( 1 7%± 0 3 % )高于保脾组CD4 ( 3 2 5 %± 4 0 % )、CD4 /CD8( 1 1%± 0 1% ) ,而CD8( 2 3 7%± 3 7% )低于保脾组CD8( 2 9 4 %± 4 0 % ) (P <0 0 5 ) ;切脾组IFN γ[( 10 4 4± 14 9)pg/ml]、IL 2 [( 98 6± 18 6)pg/ml]高于保脾组 [IFN γ( 70 5± 12 6)pg/ml、IL 2 ( 80 9± 13 5 )pg/ml],而IL 10 [( 5 5 5± 11 2 )pg/ml]低于保脾组 [IL 10 ( 89 4± 10 )pg/ml](P <0 0 5 )。　结论肝癌切除时联合脾切除不但没有降低机体T细胞亚群和Th细胞的平衡 ,反而促进其恢复平衡 ,并改善机体抗肿瘤免疫功能     

IL-10、IL-8在慢性前列腺炎中的改变及意义

目的 :研究白细胞介素 10 (IL 10 )和IL 8在慢性前列腺炎 (CP)发病机制和诊断中的作用。　方法 :随机选择各种类型的CP患者 2 9例 ,通过详细询问前列腺炎相关病史和临床症状、直肠指检前列腺及前列腺按摩液 (EPS)分析、及对部分患者进行按摩前列腺前后的尿液培养 (PPMT)法来诊断CP。选择 11例生殖功能正常的健康男子作对照。双抗体夹心ELISA法定量分析按摩前列腺后获取的精确控制的前段尿液 (VB3)内的IL 10和IL 8水平。　结果 :具有临床症状的 8例CP患者VB3中IL 10水平 [(4 7.1± 4 .5 )pg/ml]明显高于 11例健康对照者 [(4 0 .8± 5 .7)pg/ml]和 2 1例不育症中的Ⅳ型前列腺炎者 [(4 2 .7± 6 .7)pg/ml],P <0 .0 5 ;具有临床症状的 8例CP患者VB3中IL 8水平 [(1386 .2± 85 2 .6 )pg/ml]和不育症中的 13例Ⅳ型CP患者IL 8水平 [(12 0 3.8± 80 7.8)pg/ml]明显高于 7例健康对照者 [(4 12 .1± 2 17.2 )pg/ml],P <0 .0 5。　结论 :IL 10和IL 8在CP发病机制和诊断中具有重要意义 ,并可以用VB3来代替EPS或精液进行检测。     

冠心病患者围术期内皮素变化的临床研究

目的研究冠心病患者围术期内皮素（ET）及血流动力学的改变,总结冠心病围术期的一些变化规律,为临床治疗提供参考。方法将37例冠心病患者及10例心瓣膜疾病患者依据不同的手术方式分为5组,冠状动脉旁路移植术＋室壁瘤切除术（CABG＋LVAN组）,体外循环冠状动脉旁路移植术（CABG组）,非体外循环冠状动脉旁路移植术（OPCAB组）,激光心肌打孔术（TMLR组）,对照组为风湿性心脏病行二尖瓣置换术患者。使用放射免疫分析法分别测定术前,主动脉阻断前（血管移植前或打孔前）,主动脉开放时（血管移植结束时或打孔后）,心肌再灌注后3h、6h、24h血ET值;并于术前、心肌再灌注后3h、6h、24h测定心排血指数（CI）。结果ET值组内比较：CABG＋LVAN组主动脉开放时（69．93±7．20pg／ml）,心肌再灌注后3h（89．99±5．76pg／ml）、6h（60．94±8．69pg／ml）、24h（68．99±10．30pg／ml）时ET值显著高于术前（40．17±13．37pg／ml,P〈0．05）;CABG组主动脉开放时（66．59±4．86pg／ml）,心肌再灌注后3h（95．97±10．72pg／ml）、6h（61．51±7．65pg／ml）、24h（57．85±6．34pg／ml）均显著高于术前（43．22±9．13pg／ml,P〈0．05）;OPCAB组血管移植结束时（66．47±5．90pg／ml）显著高于术前（44．80±6．51pg／ml,P〈0．05）;TMLR组打孔术后无显著升高;对照组主动脉开放时（69．92±10．80pg／ml）,心肌再灌注后3h（77．99±7．49pg／ml）、6h（46．76±7．61pg／ml）、24h（52．07±6．94pg／ml）显著高于术前（35．14±8．10pg／ml,P〈0．05）。组间比较：CABG组心肌再灌注后3h显著高于OPCAB组（95．97±10．72pg／ml vs．59．72±4．81pg／ml,P〈0．05）。心肌再灌注后各组CI均较术前明显增加,CABG组心肌再灌注后3h CI明显低于OPCAB组（2．17±0．46L／min·m^2 vs．3．25±0．05L／min·m^2,P〈0．05）。?     

冠心病手术方式对IABP应用的影响

目的:探讨冠心病手术方式对主动脉内球囊反搏(intra-aortic balloon pump,IABP)的影响。方法;冠心病手术176例,27例为非体外循环心脏跳动下的手术。在149例体外循环(cardio-pulmonary bypass,CPB)下的手术中,单纯冠状动脉搭桥(coronary artery bypass grafting,CABG)35例,CABG 激光心肌血管重建(Transmyocardial Laser Revascularization,TMLR)联合手术114例,其中29例加做室壁瘤切除、室间隔穿孔修补、瓣膜置换手术,9例于术中安置临时心外膜起搏器。结果:149例体外循环下的手术中共置入IABP23例,其中120例常规手术组中应用IABP15例,29例有附加手术组中应用IABP8例,而27例非体外循环下的手术中无IABP的应用。结论:(1)应用LABP数量在常规手术组与术中加做室壁瘤切除、瓣膜置换术或成型术、室间隔穿孔修补术(p<0.05),安置临时心外膜起搏器(P<0.01),组比较结果均有统计学意义;(2)激光心肌血管重建术,无论与何种冠心病手术联合应用,无论激光打孔数量多少,都没有增加IABP的应用;(3)未发现冠脉搭桥数量与IABP有关。     

Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting.

OBJECTIVE: It has been observed that a systemic inflammatory response after on-pump coronary artery bypass grafting (CABG) participates in the pathogenesis of postoperative atrial fibrillation (AF). In patients undergoing off-pump CABG, it is plausible that inflammation is associated with the development of postoperative AF. The present study examined relation of proinflammatory cytokines, which play an important role in the upstream of inflammatory cascade, to the development of AF after off-pump CABG. METHODS: The present study included 39 patients undergoing off-pump CABG. Tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-8, were measured by enzyme-linked immunosorbent assay, on anesthetic induction, after sternotomy before anastomoses, at the completion of anastomoses, 3 and 6h thereafter, and on postoperative days (POD) 1-4. C-reactive protein (CRP) was also measured by turbidimetric immunoassay, preoperatively, and on POD 1, 2, 3, 6, 9, and 13. RESULTS: Eleven patients (28%) developed postoperative AF. Patients with postoperative AF were older (70+/-6.4 years vs 60+/-8.8 years, P=0.001); however, there was no difference in other pre- and perioperative variables. TNF-alpha level did not change during the study period. However, IL-8 and CRP levels significantly increased after the surgery, although there was no significant difference between the two groups. IL-6 level also increased after the surgery with its peak at 6h after the completion of anastomoses. IL-6 levels of 3 and 6h after anastomoses were significantly higher in patients with postoperative AF (360+/-143 pg/ml vs 230+/-94 pg/ml, P=0.0047, 435+/-175 pg/ml vs 247+/-102 pg/ml, P=0.0005, respectively). Logistic regression analysis indicated that the highest quartile of IL-6 level immediately after the surgery (odds ratio 7.63; 95% CI, 1.06-54.9; P=0.04) and age (odds ratio 1.18; 95% CI, 1.01-1.39; P=0.04) independently predict postoperative AF. Furthermore, the maximum level of IL-6 immediately after the surgery significantly correlated to age and intraoperative blood loss (r=0.04, P=0.01, and r=0.47, P=0.04, respectively). CONCLUSIONS: Advanced age was a major risk factor for postoperative AF. Furthermore, inflammatory response induced by surgical trauma was also associated with the development of AF after off-pump CABG.     

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.     

Time course of human atrial natriuretic factor release during cardiopulmonary bypass in mitral valve and coronary artery diseased patients.

We determined the time-course of the release of atrial natriuretic factor (ANF) during cardiopulmonary bypass (CPB) in six patients undergoing coronary artery bypass (CAD) and eight patients undergoing valve replacement for mitral stenosis (MS). Before CPB, the arterial ANF was significantly higher in MS patients than in CAD patients (243 +/- 38 and 29 +/- 5.8 pg/ml respectively, P less than 0.01). With the onset of CPB, the acute pressure unloading of the atria induced a significant, rapid decrease of ANF only in MS patients (-64% of pre-CPB value at 5 min) and no major changes in CAD patients. Clamping of the aorta induced a further progressive reduction of ANF release to almost zero in both groups. Readmission of coronary flow to the empty atria with declamping resulted in an increase in the plasma level of ANF in both groups to reach the concentration present in MS patients before CPB. After CPB, the ANF levels decreased in CAD patients while remaining elevated in MS patients. These data suggest that ANF release from human atria depends on atrial filling pressure and other unknown factors.     

Short-term and long-term cognitive function and cerebral perfusion in off-pump and on-pump coronary artery bypass patients.

OBJECTIVE: The aim of this study was to evaluate cognitive function, as measured by serial neuropsychological testing, and cerebral perfusion, as measured by brain SPECT scanning in patients with coronary artery diseases (CAD) following off-pump and on-pump coronary artery bypass graft surgery. Besides, the relationship between cerebral blood flow, cognitive functions, surgery parameters, and cardiac function in these patients were estimated. Also, brain-protective effects of instenon were studied. METHODS: Brain SPECT and comprehensive neuropsychological testing were performed 1 day before, 10-14 days and 6 months after coronary artery bypass graft surgery (CABG). The study involved 65 patients (62 males and 3 females, mean age 55+/-2) who underwent CABG with cardiopulmonary bypass (CPB) (43 pts) and off-pump coronary revascularization (OPCAB) using the Octopus stabilization system (22 pts). In 21 cases employing CPB, for prevention of the impairments of cerebral perfusion and cognitive deficit instenon was administered. RESULTS: CABG with the use of extracorporeal circulation is complicated by short-term and long-term neurocognitive dysfunction (in 96 and 55% cases, correspondingly). Also, in the early period after CABG, in 68% patients, decrease in regional cerebral blood flow (rCBF) was found, and after 6 months brain perfusion was lower than the baseline in 55% cases. Relationship between postoperative rCBF changes and the dynamics of cognitive function was found in early period and after 6 months following CABG. CONCLUSION: The coronary revascularization on beating heart or preventive administration of instenon in CPB patients helps significantly to diminish the risk of cerebrovascular complication.     

Is cardiopulmonary bypass a reason for aspirin resistance after coronary artery bypass grafting?

OBJECTIVE: 'Off-pump' coronary artery bypass grafting (OPCAB) is an alternative to conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). While midterm results after OPCAB have become available, systematic studies of changes in platelet function after OPCAB are still missing. Since we have previously shown that oral aspirin treatment (100mg) does not achieve sufficient platelet inhibition in the majority of patients operated on with CPB, we hypothesized that bypass surgery without CPB (off-pump coronary artery bypass, OPCAB) causes less impairment of platelet inhibition by aspirin. The aim of this study was to investigate platelet function and the antiplatelet effect of aspirin after off-pump coronary artery bypass grafting in comparison with conventional on-pump surgery. METHODS: We compared platelet function (in vitro aggregation and thromboxane formation) before and at days 1 and 5 after coronary artery bypass grafting, performed with (n=15) or without (n=14) CPB. Oral aspirin treatment (100mg/d) was started at day 1 after surgery. RESULTS: After a 5 day oral treatment with aspirin, platelet aggregation was inhibited significantly in OPCAB-patients to 55.7+/-16.3% of control before surgery (P<0.05), whereas aggregation remained unchanged after CPB (105.8+/-26.9% of control before surgery; P>0.05). Since aspirin primarily inhibits platelet thromboxane formation, thromoboxane was determined after in vitro aggregation. According to platelet aggregation, thromboxane formation was only inhibited significantly after OPCAB (29.2+/-13.0% of control before surgery, P<0.05), but not after CPB (74.5+/-21.4% of control before surgery, P>0.05). This resistance to aspirin after CPB may be caused by an increased release of new platelets which are competent to form thromboxane, since the number of platelets decreased from 237+/-11x10(3)/microl before CPB to 174+/-13x10(3)/microl at day 1 after surgery and increased significantly the following days reaching 303+/-17x10(3)/microl at day 5. Platelet counts of patients operated on without CPB showed no significant changes (236+/-16x10(3)/microl before OPCAB, 220+/-16x10(3)/microl at day 1 and 266+/-31x10(3)/microl at day 5 after surgery). CONCLUSIONS: The antiplatelet effect of aspirin is largely impaired after CPB, but not after CABG without CPB. Hence, increased platelet turnover after CPB seems to contribute to aspirin resistance, since an increased number of platelets might be competent to form thromboxane within the dosing intervals.     

Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system.

OBJECTIVE: Closed circuit extracorporeal circulation (CCECC) has been developed to reduce deleterious effects of standard cardiopulmonary bypass (CPB). This study compares the effects of CCECC (CORx system), CPB, and off-pump coronary artery bypass grafting (OPCAB) on red blood cell damage, coagulation activation, fibrinolysis and cytokine expression. METHODS: Thirty patients underwent coronary artery bypass grafting (CABG). Twenty of them were randomized into two groups: CCECC (n = 10), CPB (n = 10). While not randomized, OPCAB (n = 10) served as a separate reference group. CCECC and CPB patients received cardioplegic arrest. Interleukin 6 (IL-6), free hemoglobin (fHb), von Willebrand factor activity (vWf), thrombin-antithrombin-III-complex (TATc), prothrombin fragment 1.2 (F 1+2) and plasmin-antiplasmin complex (PAPc) were assessed preoperatively, perioperatively and 24 h postoperatively. RESULTS: CCECC showed significantly lower red blood cell damage than CPB (fHb: CCECC, 7.1+/- 5.7 micromol/l; CPB, 16.8+/-11.4 micromol/l; P = 0.025; OPCAB, 3.4+/-1.1 micromol/l). Perioperatively, CCECC exhibited significantly lower activation of coagulation and fibrinolysis than CPB, but did not differ from OPCAB (vWf: CCECC, 133+/-52%; CPB, 241+/-128%; P = 0.052; OPCAB, 153+/-58%; TATc: CCECC, 4.7+/-0.9 ng/ml; CPB, 31.1+/-15.8 ng/ml; P < 0.001; OPCAB, 2.4+/-0.6 ng/ml; PAPc: CCECC, 214+/-30 ng/ml; CPB, 897+/-367 ng/ml; P < 0.001; OPCAB, 253+/-98 ng/ml). In contrast, fibrinolysis markers and IL-6 were markedly increased in CCECC postoperatively (PAPc: CCECC, 458+/-98 ng/ml; CPB, 159+/-128 ng/ml; P < 0.001; OPCAB, 262+/-174 ng/ml; IL-6: CCECC, 123.4+/-49.8 pg/dl; CPB, 18.8+/-13.1 pg/dl; P < 0.001; OPCAB, 31.6+/-26.2 pg/dl). CONCLUSIONS: CCECC for CABG is associated with a significant reduction of red blood cell damage and activation of coagulation cascades similar to OPCAB when compared with conventional CPB while a delayed fibrinolytic and inflammatory activity was observed. These findings require further investigation to verify the promising concept of CCECC.     

Evaluation of left ventricular diastolic function during coronary artery bypass grafting by color M-mode Doppler echocardiography]

The objective of the present study was to evaluate the effects of the coronary artery bypass graft surgery (CABG) and cardioplegic arrest on left ventricular diastolic function. Ten patients with coronary artery disease were studied by transesophageal Doppler echocardiography. Doppler measurements included peak velocity during early filling (peak E velocity), peak velocity during atrial contraction (peak A velocity), and the ratio of peak E velocity to peak A velocity (E/A). The rate of propagation of peak early filling flow velocity (FPV) was also measured using color M-mode Doppler echocardiography. Hemodynamic and Doppler-derived variables were measured before and after sternotomy, after the end of cardiopulmonary bypass (CPB) and after closure of the sternum. E/A showed a significant decrease after sternotomy and did not return to the pre CPB level. FPV increased after CPB. FPV was correlated with E/A (r = 0.54, P = 0.013 pre-CPB; r = 0.54, P = 0.014 post-CPB). E/A showed a significant correlation with heart rate. After the influence of heart rate had been eliminated by the analysis of covariance, corrected E/A value showed a significant increase post-CPB compared to that in pre-CPB (0.68 +/- 0.29 to 1.10 +/- 0.29, P < 0.05). In conclusion, FPV and heart-rate-corrected E/A increased after CPB. This suggests improvement of diastolic function during CABG.     

The effects of preoperative aspirin therapy on platelet function in cardiac surgery.

Extracorporeal circulation is known to have profound effects upon platelets. Changes in platelet function were assessed in 20 patients undergoing elective coronary artery bypass grafting (CABG) who stopped taking aspirin (100 mg per day) 5-7 days before the operation compared with 20 patients undergoing aortic valve replacement (AVR) who had never taken anticoagulants or aspirin. Platelet aggregometry was carried out using the turbidimetric technique (inducing agents: adenosine diphosphate (ADP) 1.0 and 2.0 mumol/l; collagen 4 micrograms/ml; epinephrine 25 mumol/l), and maximum aggregation as well as the maximum gradient of aggregation were monitored before, during, and after cardiopulmonary bypass (CPB) until the 1st postoperative (p.o.) day. Until the 1st p.o. day blood loss was significantly higher in the CABG (890 +/- 160 ml) than in the AVR patients (420 +/- 120 ml). A total of 8 units of packed red cells (PRC) were given in the CABG group, whereas no homologous blood was necessary in the AVR patients (P < 0.05). The aggregation variables of the CABG patients were lower than in the AVR patients as early as after the induction of anesthesia (difference in maximum aggregation ranged from 13-29%). During CPB and immediately thereafter, all aggregation variables were significantly reduced in the CABG patients (reduction in maximum aggregation ranged from -32 to -49%) and were significantly different from the platelet aggregation in the AVR patients. Five hours after CPB and on the 1st p.o. day platelet aggregation in the CABG group almost returned to baseline values, however, without reaching the values of the AVR patients.(ABSTRACT TRUNCATED AT 250 WORDS)