Ashraf S, Bhattacharya K, Tian Y, Watterson K
Yorkshire Heart Centre, Leeds General Infirmary, UK.
Eur J Cardiothorac Surg. 1999 Jul;16(1):32-7. doi: 10.1016/s1010-7940(99)00136-0.
Neurological damage following cardiopulmonary bypass (CPB) is difficult to objectively evaluate in infants. In adults, serum elevations of astroglial S100B correlate with proven brain injury independent of operative temperature. The deleterious effects of inflammatory cytokines, generated during CPB, on the brain have not been studied in infants using S100B as a marker for cerebral injury.
Twelve neonates, weighing 3.3 +/- 0.2 kg (total circulatory arrest group (TCA)) and 12 infants weighing 7.0 +/- 1.0 kg (cardiopulmonary bypass group (CPB)) underwent corrective cardiac surgery for various pathologies. Serial blood samples on induction, at the end of CPB, 30 min, 2 h and 24 h after the administration of protamine, were taken. The resultant plasma was frozen to -80 degrees C and stored for batch analysis. Cytokines were measured using ELISAs and S100B using a luminometric assay.
The TCA group were younger and experienced a longer perfusion time than the CPB group (137 +/- 8 vs. 113 +/- 7, P = 0.04). The mean TCA time was 23 +/- 4 min. The TCA group had significantly higher levels of IL-6 (P = 0.001), IL-8 (P = 0.005) and S100B (P = 0.002) at 24 h. C5b-9 levels were significantly lower in the TCA group: end of CPB (P = 0.001), 30 min (P < 0.001), 2 h (P = 0.002). There was a weak, but significant correlation between IL-6 levels at the end of CPB and S100B levels 2 h later (r = 0.55, P = 0.03). Long extubation times were associated with high 24-h S100B levels (r = 0.52, P = 0.01).
(1) The TCA group have prolonged rises of IL-6, IL-8 and S100B. (2) The TCA group generates significantly lower complement. (3) Astroglial injury, seen after surgery, may, in part, be cytokine mediated.
体外循环（CPB）后婴儿的神经损伤难以进行客观评估。在成人中，星形胶质细胞S100B血清升高与已证实的脑损伤相关，且与手术温度无关。CPB期间产生的炎性细胞因子对大脑的有害影响，尚未在婴儿中以S100B作为脑损伤标志物进行研究。
12名体重3.3±0.2kg的新生儿（全循环停搏组（TCA））和12名体重7.0±1.0kg的婴儿（体外循环组（CPB））因各种病症接受了心脏矫正手术。在诱导时、CPB结束时、鱼精蛋白给药后30分钟、2小时和24小时采集系列血样。将所得血浆冷冻至-80℃并储存以进行批量分析。使用酶联免疫吸附测定法（ELISA）测量细胞因子，使用发光测定法测量S100B。
TCA组比CPB组年龄更小，灌注时间更长（137±8 vs. 113±7，P = 0.04）。平均TCA时间为23±4分钟。TCA组在24小时时IL-6（P = 0.001）、IL-8（P = 0.005）和S100B（P = 0.002）水平显著更高。TCA组C5b-9水平显著更低：CPB结束时（P = 0.001）、30分钟时（P < 0.001）、2小时时（P = 0.002）。CPB结束时的IL-6水平与2小时后的S100B水平之间存在微弱但显著的相关性（r = 0.55，P = 0.03）。长时间拔管与24小时高S100B水平相关（r = 0.52，P = 0.01）。
（1）TCA组IL-6、IL-8和S100B升高时间延长。（2）TCA组产生的补体显著更低。（3）术后出现的星形胶质细胞损伤可能部分由细胞因子介导。
