Giuliano John S, Lahni Patrick M, Bigham Michael T, Manning Peter B, Nelson David P, Wong Hector R, Wheeler Derek S
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
Intensive Care Med. 2008 Oct;34(10):1851-7. doi: 10.1007/s00134-008-1174-9. Epub 2008 May 31.
The aim was to investigate the effects of cardiopulmonary bypass (CPB) on plasma levels of the vascular growth factors, angiopoietin (angpt)-1, angpt-2, and vascular endothelial growth factor (VEGF).
The design was a prospective, clinical investigation.
The setting was a 12-bed pediatric cardiac intensive care unit of a tertiary children's medical center.
The patients were 48 children (median age, 5 months) undergoing surgical correction or palliation of congenital heart disease who were prospectively enrolled following informed consent.
There were no interventions in this study.
Plasma samples were obtained at baseline and at 0, 6, and 24 h following CPB. Angpt-1, angpt-2, and VEGF levels were measured via commercial ELISA. Angpt-2 levels increased by 6 h (0.95, IQR 0.43-2.08 ng mL(-1) vs. 4.62, IQR 1.16-6.93 ng mL(-1), P < 0.05) and remained significantly elevated at 24 h after CPB (1.85, IQR 0.70-2.76 ng mL(-1); P < 0.05). Angpt-1 levels remained unchanged immediately after CPB, but were significantly decreased at 24 h after CPB (0.64, IQR 0.40-1.62 ng mL(-1) vs. 1.99, IQR 1.23-2.63 ng mL(-1), P < 0.05). Angpt-2 levels correlated significantly with cardiac intensive care unit (CICU) length of stay (LOS) and were an independent predictor for CICU LOS on subsequent multivariate analysis.
Angpt-2 appears to be an important biomarker of adverse outcome following CPB in children.
旨在研究体外循环（CPB）对血管生成因子、血管生成素（angpt）-1、血管生成素-2及血管内皮生长因子（VEGF）血浆水平的影响。
前瞻性临床研究。
一家三级儿童医学中心设有12张床位的儿科心脏重症监护病房。
48例接受先天性心脏病手术矫治或姑息治疗的儿童（中位年龄5个月），在获得知情同意后前瞻性入组。
本研究无干预措施。
在基线时以及CPB后0、6和24小时采集血浆样本。通过商业酶联免疫吸附测定法（ELISA）测量血管生成素-1、血管生成素-2和VEGF水平。血管生成素-2水平在6小时时升高（0.95，四分位间距0.43 - 2.08 ng/mL与4.62，四分位间距1.16 - 6.93 ng/mL，P < 0.05），并在CPB后24小时仍显著升高（1.85，四分位间距0.70 - 2.76 ng/mL；P < 0.05）。血管生成素-1水平在CPB后即刻保持不变，但在CPB后24小时显著降低（0.64，四分位间距0.40 - 1.62 ng/mL与1.99，四分位间距1.23 - 2.63 ng/mL，P < 0.05）。血管生成素-2水平与心脏重症监护病房（CICU）住院时间（LOS）显著相关，并且在随后的多因素分析中是CICU LOS的独立预测指标。
血管生成素-2似乎是儿童CPB后不良结局的重要生物标志物。
