Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
J Thorac Cardiovasc Surg. 2017 Jan;153(1):68-76.e2. doi: 10.1016/j.jtcvs.2016.05.063. Epub 2016 Sep 14.
Aortic surgeries requiring hypothermic circulatory arrest evoke systemic inflammatory responses that often manifest as vasoplegia and hypotension. Because mast cells can rapidly release vasoactive and proinflammatory effectors, we investigated their role in intraoperative hypotension.
We studied 31 patients undergoing proximal aortic repair with hypothermic circulatory arrest between June 2013 and April 2015 at Duke University Medical Center. Plasma samples were obtained at different intraoperative time points to quantify chymase, interleukin-6, interleukin-8, tumor necrosis factor alpha, and white blood cell CD11b expression. Hypotension was defined as the area (minutes × millimeters mercury) below a mean arterial pressure of 55 mm Hg. Biomarker responses and their association with intraoperative hypotension were analyzed by 2-sample t test and Wilcoxon rank sum test. Multivariable logistic regression analysis was used to examine the association between clinical variables and elevated chymase levels.
Mast cell-specific chymase increased from a median 0.97 pg/mg (interquartile range [IQR], 0.01-1.84 pg/mg) plasma protein at baseline to 5.74 pg/mg (IQR, 2.91-9.48 pg/mg) plasma protein after instituting cardiopulmonary bypass, 6.16 pg/mg (IQR, 3.60-9.41 pg/mg) plasma protein after completing circulatory arrest, and 7.64 pg/mg (IQR, 4.63-12.71 pg/mg) plasma protein after weaning from cardiopulmonary bypass (each P value < .0001 vs baseline). Chymase was the only biomarker associated with hypotension during (P = .0255) and after (P = .0221) cardiopulmonary bypass. Increased temperatures at circulatory arrest and low presurgical hemoglobin levels were independent predictors of increased chymase responses.
Mast cell activation occurs in cardiac surgery requiring cardiopulmonary bypass and hypothermic circulatory arrest and is associated with intraoperative hypotension.
需要低温循环停止的主动脉手术会引起全身炎症反应，这些反应通常表现为血管麻痹和低血压。由于肥大细胞可以迅速释放血管活性和促炎效应物，我们研究了它们在术中低血压中的作用。
我们研究了 2013 年 6 月至 2015 年 4 月在杜克大学医学中心接受近端主动脉修复术并伴有低温循环停止的 31 例患者。在不同的术中时间点获得血浆样本，以定量检测糜酶、白细胞介素 6、白细胞介素 8、肿瘤坏死因子 α 和白细胞 CD11b 的表达。低血压定义为平均动脉压低于 55mmHg 的区域（分钟×毫米汞柱）。通过两样本 t 检验和 Wilcoxon 秩和检验分析生物标志物反应及其与术中低血压的关系。采用多变量逻辑回归分析检查临床变量与升高的糜酶水平之间的关系。
肥大细胞特异性糜酶从基线时的中位数 0.97pg/mg（四分位距[IQR]，0.01-1.84pg/mg）血浆蛋白增加至心肺转流后 5.74pg/mg（IQR，2.91-9.48pg/mg）血浆蛋白，停循环后 6.16pg/mg（IQR，3.60-9.41pg/mg）血浆蛋白，心肺转流脱机后 7.64pg/mg（IQR，4.63-12.71pg/mg）血浆蛋白（各 P 值均<0.0001 与基线相比）。在心肺转流期间（P=0.0255）和之后（P=0.0221），糜酶是唯一与低血压相关的生物标志物。循环停止时温度升高和术前血红蛋白水平低是增加糜酶反应的独立预测因子。
心脏手术需要心肺转流和低温循环停止时会发生肥大细胞激活，并与术中低血压相关。
