Aĝirbaşli Mehmet, Song Jianxun, Lei Fengyang, Wang Shigang, Kunselman Allen R, Clark Joseph B, Myers John L, Ündar Akif
Department of Cardiology, Marmara University College of Medicine, Istanbul, Turkey.
Artif Organs. 2015 Jan;39(1):28-33. doi: 10.1111/aor.12444.
Apolipoprotein E (apoE) may play a critical role in modulating the response to neurological injury after cardiopulmonary bypass (CPB) in children. Plasma samples were collected from 38 pediatric patients. Half of the patients received nonpulsatile flow and the other half underwent pulsatile flow during CPB. Plasma samples were collected at three time points: at baseline prior to incision (T1), 1 h after CPB (T2), and 24 h after CPB (T3). The study included 38 pediatric patients undergoing heart surgery (mean age 2.5 ± 2.1 years). Baseline apoE levels were low (<30 μg/mL) in 21 patients (55%). ApoE levels were significantly decreased at 1 h after CPB compared with baseline (22 ± 14 vs. 34 ± 18 μg/mL, P = 0.001). At 24 h after CPB, apoE levels were significantly increased compared with baseline (47 ± 25 vs. 34 ± 18 μg/mL, P = 0.002). Pulsatile mode was associated with lower apoE levels at 24 h after CPB compared with nonpulsatile mode (38 ± 14 vs. 57 ± 29 μg/mL, P = 0.018). ApoE levels correlated negatively with pump time (r = -0.525, P = 0.021) and cross-clamp time (r = -0.464, P = 0.045) at 24 h following CPB for the nonpulsatile group but not for the pulsatile group. In this cohort of young children with congenital heart disease, baseline apoE levels were low in the majority of patients prior to surgery. ApoE levels decreased further at 1 h after CPB, and then significantly increased by 24 h. The mode of perfusion and the duration of pump time and clamp time influence the apoE levels after CPB. An improved understanding of these mechanisms may translate into the development of new techniques to improve the clinical outcomes after pediatric CPB.
载脂蛋白E（apoE）可能在调节儿童体外循环（CPB）后对神经损伤的反应中起关键作用。从38名儿科患者中采集血浆样本。一半患者在CPB期间接受非搏动血流，另一半接受搏动血流。在三个时间点采集血浆样本：切口前基线（T1）、CPB后1小时（T2）和CPB后24小时（T3）。该研究纳入了38名接受心脏手术的儿科患者（平均年龄2.5±2.1岁）。21名患者（55%）的基线apoE水平较低（<30μg/mL）。与基线相比，CPB后1小时apoE水平显著降低（22±14 vs. 34±18μg/mL，P = 0.001）。CPB后24小时，apoE水平与基线相比显著升高（47±25 vs. 34±18μg/mL，P = 0.002）。与非搏动模式相比，搏动模式在CPB后24小时与较低的apoE水平相关（38±14 vs. 57±29μg/mL，P = 0.018）。对于非搏动组，CPB后24小时apoE水平与泵血时间（r = -0.525，P = 0.021）和阻断时间（r = -0.464，P = 0.045）呈负相关，而搏动组则不然。在这一先天性心脏病幼儿队列中，大多数患者术前基线apoE水平较低。CPB后1小时apoE水平进一步降低，然后在24小时时显著升高。灌注模式以及泵血时间和阻断时间会影响CPB后的apoE水平。对这些机制的深入了解可能会转化为开发新技术，以改善儿科CPB后的临床结局。
