Brunner Michael P, Shah Svati H, Craig Damian M, Stevens Robert D, Muehlbauer Michael J, Bain James R, Newgard Christopher B, Kraus William E, Granger Christopher B, Sketch Michael H, Newby L Kristin
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Circ Cardiovasc Genet. 2011 Dec;4(6):695-700. doi: 10.1161/CIRCGENETICS.111.960575. Epub 2011 Oct 18.
Metabolic profiling holds promise for early detection of coronary artery disease and assessing risk for ischemic events. Heparin is frequently administered (1) to treat acute coronary syndromes; and (2) during routine cardiac catheterization procedures. Because it stimulates lipolysis, heparin is a potential confounder of metabolic profiling in these populations.
Using mass spectrometry and conventional immunoassays, we evaluated how unfractionated heparin administration affected 69 peripheral blood metabolites (acylcarnitines, amino acids, nonesterified fatty acids and their oxidation byproducts, conventional lipids, glucose, and C-reactive protein) in samples obtained pre- and postcardiac catheterization from 19 patients who received heparin and 10 patients who did not. Using unpaired t tests, we compared the changes in mean metabolite levels before and after the procedure between the nonheparin and heparin groups. Clinical characteristics of the nonheparin and heparin groups, indication for cardiac catheterization, procedure performed, and other periprocedural variables were similar. The mean change between pre- and postprocedure β-hydroxybutyrate (5.43 versus 66.84 μmol/L; P=0.009), ketones (21.17 versus 98.49 μmol/L; P=0.009), nonesterified fatty acids (0.37 versus 1.20 mmol/L; P=0.017), and triglycerides (-9.33 versus -36.50 mg/dL; P=0.007) was significantly different between the nonheparin and heparin groups, respectively. There were no significant differences between groups in the other metabolites measured.
Heparin administration during cardiac catheterization induced changes in peripheral blood metabolites that were consistent with known lipolytic effects of heparin and define a metabolite signature associated with heparin administration. These findings are important for accurate interpretation of future metabolic profiling studies in populations exposed to heparin.
代谢谱分析有望用于冠状动脉疾病的早期检测及评估缺血事件风险。肝素常用于：（1）治疗急性冠状动脉综合征；（2）常规心脏导管插入术过程中。由于肝素会刺激脂肪分解，它可能会混淆这些人群的代谢谱分析结果。
我们采用质谱分析法和传统免疫分析法，评估了19例接受肝素治疗的患者和10例未接受肝素治疗的患者在心脏导管插入术前及术后采集的样本中，普通肝素的使用对69种外周血代谢物（酰基肉碱、氨基酸、非酯化脂肪酸及其氧化产物、传统脂质、葡萄糖和C反应蛋白）的影响。我们使用非配对t检验，比较了非肝素组和肝素组在手术前后平均代谢物水平的变化。非肝素组和肝素组的临床特征、心脏导管插入术指征、所进行的手术以及其他围手术期变量相似。非肝素组和肝素组在手术前后β-羟基丁酸（5.43对66.84 μmol/L；P=0.009）、酮体（21.17对98.49 μmol/L；P=0.009）、非酯化脂肪酸（0.37对1.20 mmol/L；P=0.017）和甘油三酯（-9.33对-36.50 mg/dL；P=0.007）的平均变化分别有显著差异。两组间其他检测的代谢物无显著差异。
心脏导管插入术期间使用肝素会引起外周血代谢物变化，这与肝素已知的脂肪分解作用一致，并确定了与肝素使用相关的代谢物特征。这些发现对于准确解读未来在接触肝素人群中进行的代谢谱分析研究具有重要意义。
