术中支持策略对内皮损伤和临床肺移植结果的影响

IF 2.6 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

在肺移植术中,术中使用体外膜肺氧合(ECMO)比使用心肺旁路(CBP)更有利于术后效果。我们研究了术中支持策略对内皮损伤生物标志物和移植后短期预后的影响。研究对象包括接受无支持、静脉动脉 (V-A) ECMO 或 CPB 双侧肺移植手术的成人。采集移植前和移植后的血浆样本进行 Luminex 检测,以测量内皮损伤生物标记物,包括辛迪加-1(SYN-1)、细胞间粘附分子-1(ICAM-1)和基质金属蛋白酶-9。55 名患者被纳入分析。与 V-A ECMO 和无支持相比,CPB 患者到达重症监护室时的血浆 SYN-1 水平明显更高(P < 0.01)。在 72 小时内,CPB 的原发性移植物功能障碍 3 级(PGD3)发生率为 60.0%,V-A ECMO 为 40.1%,无支持为 15%(P = 0.01)。术后 72 小时出现 PGD3 的受者血浆中 SYN-1 和 ICAM-1 水平明显更高。移植后出现急性肾损伤和肝功能障碍的患者的 SYN-1 水平也明显较高。研究发现,术后到达重症监护室时的 SYN-1 是肺移植术后 PGD3、急性肾损伤和肝功能异常的重要预测生物标志物。CPB 与到达重症监护室时血浆中较高的 SYN-1 浓度有关,SYN-1 是内皮细胞糖萼降解的标志物。较高水平的SYN-1可预测肺移植后的内脏器官功能障碍。我们的数据表明,旨在调节内皮损伤的术中策略将有助于改善肺移植的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes

Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes

Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes

In lung transplantation, postoperative outcomes favor intraoperative use of extracorporeal membrane oxygenation (ECMO) over cardiopulmonary bypass (CBP). We investigated the effect of intraoperative support strategies on endothelial injury biomarkers and short-term posttransplant outcomes. Adults undergoing bilateral lung transplantation with No-Support, venoarterial (V-A) ECMO, or CPB were included. Plasma samples pre- and post-transplant were collected for Luminex assay to measure endothelial injury biomarkers including syndecan-1 (SYN-1), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloprotease-9. Fifty five patients were included for analysis. The plasma level of SYN-1 at arrival in the intensive care unit was significantly higher with CPB compared to V-A ECMO and No-Support (P < 0.01). The rate of primary graft dysfunction grade 3 (PGD3) at 72 hours was 60.0% in CPB, 40.1% in V-A ECMO, and 15% in No-Support (P = 0.01). Postoperative plasma levels of SYN-1 and ICAM-1 were significantly higher in recipients who developed PGD3 at 72 hours. SYN-1 levels were also significantly higher in patients who developed acute kidney injury and hepatic dysfunction after transplant. Postoperative, SYN-1 upon intensive care arrival was found to be a significant predictive biomarker of PGD3, acute kidney injury, and hepatic dysfunction following lung transplantation. CPB is associated with higher plasma concentrations of SYN-1, a marker of endothelial glycocalyx degradation, upon arrival to the intensive care unit. Higher levels of SYN-1 are predictive of end-organ dysfunction following lung transplantation. Our data suggests that intraoperative strategies aimed at modulating endothelial injury will help improve lung transplantation outcomes.

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来源期刊
Seminars in Thoracic and Cardiovascular Surgery
Seminars in Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine
CiteScore
5.80
自引率
0.00%
发文量
324
审稿时长
12 days
期刊介绍: Seminars in Thoracic and Cardiovascular Surgery is devoted to providing a forum for cardiothoracic surgeons to disseminate and discuss important new information and to gain insight into unresolved areas of question in the specialty. Each issue presents readers with a selection of original peer-reviewed articles accompanied by editorial commentary from specialists in the field. In addition, readers are offered valuable invited articles: State of Views editorials and Current Readings highlighting the latest contributions on central or controversial issues. Another prized feature is expert roundtable discussions in which experts debate critical questions for cardiothoracic treatment and care. Seminars is an invitation-only publication that receives original submissions transferred ONLY from its sister publication, The Journal of Thoracic and Cardiovascular Surgery. As we continue to expand the reach of the Journal, we will explore the possibility of accepting unsolicited manuscripts in the future.
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