体外循环下冠脉搭桥术后内皮功能异常和脂质氧化状态变化

目的评价体外循环对冠脉搭桥患者术后内皮功能和脂质氧化状态的影响。方法35例需要进行冠脉搭桥(CABG)手术的患者(女性5例,男性30例,年龄59.5±8.6岁)和20例正常对照者(女性5例,男性15例,年龄49.5±7.3岁)收入本研究。在术前、术后3天和术后7天采集血样。血浆vonWillebrand因子(vWF)和氧化低密度脂蛋白(oxidizedlowdensitylipid,OxLDL)水平分别代表了内皮功能异常和脂质氧化情况,均采用ELISA试剂盒检测。结果冠脉搭桥患者术前vWF和OxLDL水平较正常对照显著升高,分别为139.60%±34.39%vs82.79%±13.89%和63.7±18.9U/mlvs25.4±15.2U/ml。术后3天和7天,冠脉搭桥患者的vWF水平与术前相比显著升高,分别为194.30%±37.74%;181.07%±31.05%vs139.60%±34.39%(P<0.0001),OxLDL水平也显著升高,分别为79.3±26.7U/ml;72.4±23.1U/mlvs63.7±18.9U/ml(P<0.01)。结论与正常人群相比,CABG患者的内皮显著受损,脂质氧化水平显著升高。体外循环下CABG手术会加剧这些改变,提示术后患者更容易发生急性冠脉事件。

Endothelial dysfunction and lipid oxidation status after coronary artery bypass grafting procedure under cardio-pulmonary bypass

Objectives To evaluate the influence of cardio-pulmonary bypass (CPB) to the endothelial function and lipid oxidative status of the Coronary Artery Bypass Grafting (CABG) patients. Methods Thirty-five coronary patients (female 5 cases, male 30 cases, mean age 59.5±8. 6 years) who needed CABG operation therapy were included. The control group consisted of 20 health volunteers (female 5 cases, male 15 cases, mean age 49. 5 ± 7.3 years).Blood samples were taken at preoperative, 3 and 7 days postoperative. Serum von Willebrand factor (vWF) level, one of the endothelial dysfunction markers,and oxidized low density lipid (OxLDL) level, one of the lipid oxidization status markers were detected with ELISA kits. Results The levels of vWF and OxLDL in CABG patients' serum were elevated significantly compared with those of control group ( 139.60% ± 34. 39% vs 82. 79% ±13. 89% and 63. 7 ±18. 9U/ml vs 25.4± 15.2U/ml respectively). Three and 7 days after CABG significant increases in the vWF level (194. 30% ±37. 74%; 181.07% ±31.05%vs 139.60% ±34.39% at baseline, P＜0. 0001, respectively) and OxLDL level (79. 3±26. 7U/ml; 72.4±23.1U/ml vs 63.7±18. 9U/ml at baseline, P＜0. 01, respectively) were detected. Conclusion Compared with normal people, the endothelial system of CABG patients is impaired, and their lipids are in a more oxidative status. CABG procedure with CPB can further deteriorate the conditions, which may imply that the patients are predisposed to acute coronary accident shortly are the procedure.