Bruegger Dirk, Brettner Florian, Rossberg Isabel, Nussbaum Claudia, Kowalski Christian, Januszewska Katarzyna, Becker Bernhard F, Chappell Daniel
Department of Anesthesiology, University Hospital of Munich, Munich, Germany.
Department of Anesthesiology, University Hospital of Munich, Munich, Germany; Walter-Brendel Centre of Experimental Medicine, University of Munich, Munich, Germany.
Ann Thorac Surg. 2015 Mar;99(3):926-31. doi: 10.1016/j.athoracsur.2014.10.013. Epub 2015 Jan 17.
There is no doubt today about the existence of the endothelial glycocalyx (EG) and its decisive role in maintaining vascular homeostasis in adult humans. Shedding of the EG has been demonstrated in adults with sepsis or trauma, in patients undergoing major operations, and after ischemia/reperfusion. The aim of the present study was to demonstrate whether shedding of the EG also occurs in infants undergoing heart operations.
Two major constituents of the EG (syndecan-1 and hyaluronan) were measured in the arterial serum of 42 infants during cardiac operations in a prospective observational study. The groups were defined according to the ischemic impact: cardiac operations with cardiopulmonary bypass under beating heart conditions (CPB group, regional ischemia of lungs, n = 10), operations with cardiopulmonary bypass and aortic clamping (CPB+AC group, regional ischemia of heart and lungs, n = 24), and cardiac operations with deep hypothermic circulatory arrest (CPB+AC+DHCA group, whole-body ischemia, n = 8).
Syndecan-1 and hyaluronan were detected in all infants, providing an indication for the presence of a glycocalyx. During the operations, no significant difference in syndecan-1 concentration was observed in the CPB group, but levels increased significantly in both other groups (maximum increases: CPB+AC 3.0-fold, CPB+AC+DHCA 3.7-fold, p < 0.05). Hyaluronan increased significantly in the course of the operation in all groups (maximum increases: CPB 1.2-fold, CPB+AC 1.4-fold, CPB+AC+DHCA 1.7-fold, p < 0.05).
The present data provides the first evidence for basal turnover of vascular EG in infants. Similarly to the process in adults, the shedding of this structure increases with ischemia/reperfusion, the extent being dependent on the degree of ischemic challenge.
如今，内皮糖萼（EG）的存在及其在维持成年人体内血管稳态中的决定性作用已毋庸置疑。在患有脓毒症或创伤的成年人、接受大手术的患者以及缺血/再灌注后，均已证实存在EG脱落现象。本研究的目的是证明在接受心脏手术的婴儿中是否也会发生EG脱落。
在一项前瞻性观察研究中，对42例婴儿在心脏手术期间的动脉血清中EG的两种主要成分（syndecan-1和透明质酸）进行了测量。根据缺血影响将各组进行定义：在心脏跳动条件下进行体外循环的心脏手术（CPB组，肺部局部缺血，n = 10）、进行体外循环和主动脉钳夹的手术（CPB+AC组，心脏和肺部局部缺血，n = 24）以及进行深低温循环停搏的心脏手术（CPB+AC+DHCA组，全身缺血，n = 8）。
在所有婴儿中均检测到syndecan-1和透明质酸，这表明存在糖萼。在手术过程中，CPB组中syndecan-1浓度未观察到显著差异，但其他两组中的水平均显著升高（最大增幅：CPB+AC组为3.0倍，CPB+AC+DHCA组为3.7倍，p < 0.05）。在所有组中，透明质酸在手术过程中均显著增加（最大增幅：CPB组为1.2倍，CPB+AC组为1.4倍，CPB+AC+DHCA组为1.7倍，p < 0.05）。
本数据首次为婴儿血管EG的基础更新提供了证据。与成年人的过程类似，这种结构的脱落随着缺血/再灌注而增加，其程度取决于缺血挑战的程度。
