Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Kidney Int. 2010 May;77(10):913-20. doi: 10.1038/ki.2010.24. Epub 2010 Feb 24.
Hemolysis is an inevitable side effect of cardiopulmonary bypass resulting in increased plasma free hemoglobin that may impair tissue perfusion by scavenging nitric oxide. Acute kidney injury after on-pump cardiovascular surgery arises from a number of causes and severely affects patient morbidity and mortality. Here, we studied the effect of acute hemolysis on renal injury in 35 patients undergoing on-pump surgical repair of thoracic and thoracoabdominal aortic aneurysms of whom 19 experienced acute kidney injury. During surgery, plasma free hemoglobin increased, as did urinary excretion of the tubular injury marker N-acetyl-beta-D-glucosaminidase, in patients with and without acute kidney injury, reaching peak levels at 2 h and 15 min, respectively, after reperfusion. Furthermore, plasma free hemoglobin was independently and significantly correlated with the urine biomarker, which, in turn, was independently and significantly associated with the later postoperative increase in serum creatinine. Importantly, peak plasma free hemoglobin and urine N-acetyl-beta-D-glucosaminidase concentrations had significant predictive value for postoperative acute kidney injury. Thus, we found an association between increased plasma free hemoglobin and renal injury casting new light on the pathophysiology of acute kidney injury. Therefore, free hemoglobin is a new therapeutic target to improve clinical outcome after on-pump cardiovascular surgery.
溶血是体外循环不可避免的副作用，导致血浆游离血红蛋白增加，从而通过清除一氧化氮而损害组织灌注。体外循环心血管手术后发生急性肾损伤是由多种原因引起的，严重影响患者的发病率和死亡率。在这里，我们研究了 35 名接受胸主动脉和胸腹主动脉瘤体外循环手术修复的患者中急性溶血对肾损伤的影响，其中 19 名患者发生急性肾损伤。在手术过程中，血浆游离血红蛋白增加，肾小管损伤标志物 N-乙酰-β-D-氨基葡萄糖苷酶的尿排泄也增加，在发生和未发生急性肾损伤的患者中，分别在再灌注后 2 小时和 15 分钟达到峰值。此外，血浆游离血红蛋白与尿生物标志物独立且显著相关，而尿生物标志物反过来与术后血清肌酐的后期增加独立且显著相关。重要的是，血浆游离血红蛋白和尿 N-乙酰-β-D-氨基葡萄糖苷酶浓度的峰值对术后急性肾损伤有显著的预测价值。因此，我们发现了血浆游离血红蛋白增加与肾损伤之间的关联，为急性肾损伤的病理生理学提供了新的认识。因此，游离血红蛋白是改善体外循环心血管手术后临床转归的新治疗靶点。
