冠心病合并急性肾损伤患者冠状动脉搭桥术后的先天免疫反应,取决于体外循环时间

O. Fomina, E. Chagina, L. Fedyanina, V. E. Krasnikov
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引用次数: 0

摘要

21世纪,由于预期寿命延长,慢性病的发病率有所增加。心血管疾病是世界上最常见的疾病,发病率和死亡率都很高。随着这种疾病的患病率增加,心脏手术已成为对药物和其他治疗方法无效的患者的基本策略。心脏手术的一些潜在并发症在术后影响肾脏、肺和脑。急性肾损伤(AKI)被认为是心脏手术的严重并发症,其特点是肾功能迅速丧失,导致血清肌酐浓度急性升高。心脏手术后AKI发生率高达30%,孤立冠状动脉旁路移植术(CABG)患者AKI发生率为2%。有文献资料显示,冠状动脉搭桥术后并发冠状动脉粥样硬化的患者。在这项工作中,炎症和先天免疫失调的发展得到了证实。细胞因子系统失衡有助于内皮功能障碍的进展,并可能促进CABG后肾损伤的发展。AKI患者的高细胞素血症提示先天免疫因子参与急性炎症反应的发展。本文旨在探讨不同体外循环时间冠脉搭桥患者的先天免疫反应。在本研究中,100例患者接受了冠脉搭桥,所有患者均为非泵组。在工作中使用了一般的临床、功能、生化、仪器、免疫学和统计学方法。通过分析1期和2期AKI (KDIGO)患者血清中促炎因子和抗炎因子含量随体外循环手术时间的变化,我们发现其动态符合CABG组后的标准变化模式,以及体外循环时间较长的组促炎因子和抗炎因子的过量产生。促炎和抗炎介质的发病作用尚不清楚。我们支持体外循环术后临床预后取决于促炎性和抗炎性细胞因子平衡的观点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Innate immune response in the patients with heart disease and acute kidney injury after coronary artery bypass grafting, depending on the duration of extracorporeal circulation
Incidence of chronic diseases is increased in the 21st century due to prolonged life expectancy. Cardiovascular disease is the most common disorder worldwide, complicated with high morbidity and mortality. Upon increased prevalence of this disease, cardiac surgery has become an essential strategy for patients that do not respond to medications and other therapeutic procedures. Some potential complications in cardiac surgery affect kidneys, lung, brain over the postoperative period. Acute kidney injury (AKI) is considered a serious complication of cardiac surgery characterized by rapid loss of kidney function leading to acute increase in the serum creatinine concentration. AKI occurs in up to 30% of patients after cardiac surgery and is observed in 2% of the cases with isolated coronary artery bypass grafting (CABG). There are literature data concerning the patients with coronary artery disease after CABG in the presence of evolving atherosclerosis. Development of inflammation and dysadaptation of innate immunity was established in this work. An imbalance in the cytokine system contributes to the progression of endothelial dysfunction and may promote development of renal injury after CABG. Hypercytokinemia in AKI patients suggests involvement of innate immunity factors in the development of acute inflammatory response. The purpose of this article was to assess the innate immune response in the patients subjected to CABG with different duration of extracorporeal circulation. In the present study, 100 patients underwent CABG, all of whom were in the on-pump group. General clinical, functional, biochemical, instrumental, immunological and statistical methods were used in the work. After analyzing the data on the content of pro- and anti-inflammatory cytokines in blood serum of the patients with stage 1 and 2 AKI (KDIGO), depending on the duration of cardiopulmonary bypass surgery, we found that their dynamics corresponded to the standard pattern of changes after CABG groups and hyperproduction of pro- and anti-inflammatory cytokines in the groups with higher duration of cardiopulmonary bypass. The pathogenetic role of pro- and anti-inflammatory mediators remains unclear. We support the view that the clinical prognosis after cardiopulmonary bypass depends on the balance of pro- and anti-inflammatory cytokines.
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