Sablotzki A, Börgermann J, Baulig W, Friedrich I, Spillner J, Silber R E, Czeslick E
Clinic of Anesthesiology and Intensive Care Medicine, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle/Saale, Germany.
Thorac Cardiovasc Surg. 2001 Oct;49(5):273-8. doi: 10.1055/s-2001-17803.
Cardiopulmonary bypass (CPB) is associated with an immunological injury that may cause pathophysiological alterations in the form of a systemic inflammatory response syndrome (SIRS) or a multiple organ dysfunction syndrome (MODS). Previous studies on this issue have reported different changes of immunological parameters during and after CPB, but there are no reports about the lipopolysaccharide-binding protein (LBP) in relationship to other markers of inflammation in patients with MODS following cardiovascular surgery. In the present study, we investigated the acute-phase response of patients with MODS of infectious and non-infectious origin following open-heart-surgery. Plasma levels of procalcitonin (PCT), c-reactive protein (CRP), interleukin-6 (IL-6), and LBP were measured in the first four postoperative days in 12 adult male patients with the signs of SIRS and two or more organ dysfunctions after myocardial revascularization (MODS-group), and 12 patients without organ insufficiencies (SIRS-group). There were no significant differences regarding age, weight, height, preoperative NYHA-classification, preoperative LVEDP, or the number of anastomosis. Patients with MODS had a significantly longer operation time, duration of ischemia, and duration of extracorporeal circulation. None of the patients in the SIRS group died, whereas in the MODS group, 4 patients died due to septic multiorgan failure. Plasma PCT and IL-6 concentrations were significantly elevated in all MODS patients. CRP and LBP showed no differences between the MODS and the SIRS group. Comparing the MODS patients with and without positive microbial findings, we found significantly elevated levels of PCT and LBP in those patients with documented infections. Our results indicate that LBP may be a new marker for the differentiation between a severe non-infectious SIRS and an ongoing bacterial sepsis in the early postoperative course following CPB, while a microbiological result is still missing.
体外循环（CPB）与免疫损伤相关，这种损伤可能以全身炎症反应综合征（SIRS）或多器官功能障碍综合征（MODS）的形式引起病理生理改变。此前关于此问题的研究报道了CPB期间及之后免疫参数的不同变化，但尚无关于心血管手术后发生MODS患者的脂多糖结合蛋白（LBP）与其他炎症标志物关系的报道。在本研究中，我们调查了心脏直视手术后感染性和非感染性病因导致MODS患者的急性期反应。在12例出现SIRS体征且心肌血运重建后有两个或更多器官功能障碍的成年男性患者（MODS组）以及12例无器官功能不全的患者（SIRS组）术后的前四天，测量了血浆降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）和LBP的水平。在年龄、体重、身高、术前纽约心脏协会（NYHA）分级、术前左心室舒张末期压力（LVEDP）或吻合口数量方面，两组无显著差异。MODS患者的手术时间、缺血时间和体外循环时间明显更长。SIRS组无患者死亡，而MODS组有4例患者因感染性多器官功能衰竭死亡。所有MODS患者的血浆PCT和IL-6浓度均显著升高。MODS组和SIRS组之间CRP和LBP无差异。比较有和无微生物阳性结果的MODS患者，我们发现有感染记录的患者中PCT和LBP水平显著升高。我们的结果表明，在CPB术后早期，当微生物学结果尚未明确时，LBP可能是区分严重非感染性SIRS和持续性细菌败血症的新标志物。
