Meng Qing H, Zhu Shiming, Sohn Namseok, Mycyk Taras, Shaw Susan A, Dalshaug Greg, Krahn John
Department of Pathology and Laboratory Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. mail:
J Card Surg. 2008 Nov-Dec;23(6):681-7. doi: 10.1111/j.1540-8191.2008.00701.x. Epub 2008 Sep 5.
Determination of cardiac markers can assess cardiac injury induced by cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG). However, the markers and their release pattern are not well defined. This study was aimed at assessing the release and timing of cardiac biochemical and inflammatory markers in patients undergoing elective CABG with CPB.
Forty patients undergoing elective CABG were included in this study. Blood samples were collected for biochemical measurements at the following time points: immediately prior to the induction of anesthesia, one, six, 12, and 24 hours after initiation of CPB.
Increased release of cardiac troponin I was observed one hour after initiation of CPB (p < 0.05) and reached the maximum at 12 hours after CPB (p < 0.01). Serum CK-MB enzyme activity and CK-MB mass both were highly elevated starting at one hour after initiation of CPB, peaked at six hours, and remained elevated until 24 hours after CPB. Both lactate and lactate dehydrogenase were highly elevated six hours after CPB and peaked at 12 hours after CPB (p < 0.01). Serum levels of interleukin-6 and tumor necrosis factor-alpha increased significantly one hour after initiation of CPB and peaked at six hours (p < 0.01), while serum high sensitivity C-reactive protein levels started to elevate 12 hours after CPB (p < 0.01).
Monitoring of these markers could help to determine implementation of protective interventions during CABG with CPB to prevent myocardial deterioration and to predict the risk and prognosis.
测定心脏标志物可评估冠状动脉旁路移植术（CABG）期间体外循环（CPB）所致的心脏损伤。然而，这些标志物及其释放模式尚未明确界定。本研究旨在评估接受择期CABG并行CPB患者心脏生化和炎症标志物的释放情况及时间。
本研究纳入40例接受择期CABG的患者。在以下时间点采集血样进行生化检测：麻醉诱导前即刻、CPB开始后1小时、6小时、12小时和24小时。
CPB开始后1小时观察到心肌肌钙蛋白I释放增加（p<0.05），并在CPB后12小时达到峰值（p<0.01）。血清肌酸激酶同工酶（CK-MB）酶活性和CK-MB质量从CPB开始后1小时均显著升高，在6小时达到峰值，并持续升高至CPB后24小时。乳酸和乳酸脱氢酶在CPB后6小时均显著升高，并在CPB后12小时达到峰值（p<0.01）。血清白细胞介素-6和肿瘤坏死因子-α水平在CPB开始后1小时显著升高，并在6小时达到峰值（p<0.01），而血清高敏C反应蛋白水平在CPB后12小时开始升高（p<0.01）。
监测这些标志物有助于确定在CPB辅助下进行CABG期间实施保护性干预措施，以预防心肌恶化，并预测风险和预后。
