Tyvold Stig S, Dahl Torbjørn, Dragsund Stein, Gunnes Sigurd, Lyng Oddveig, Damås Jan K, Aadahl Petter, Solligård Erik
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Physiol Rep. 2017 Jul;5(14). doi: 10.14814/phy2.13348.
Aortic surgery results in ischemia-reperfusion injury that induces an inflammatory response and frequent complications. The magnitude of the inflammatory response in blood and bronchi may be associated with the risk of immediate complications. The purpose of the study was to evaluate bronchial microdialysis as a continuous monitoring of cytokines in bronchial epithelial lining fluid (ELF) and to determine whether bronchial ELF cytokine levels reflect the ischemia-reperfusion injury and risk for complications during open abdominal aortic aneurysm (AAA) repair. We measured cytokines in venous blood using microdialysis and in serum for comparison. Sixteen patients scheduled for elective open AAA repair were included in a prospective observational study. Microdialysis catheters were introduced into a bronchi and a cubital vein. Eighteen cytokines were measured using a Bio-Plex Magnetic Human Cytokine Panel. Samples were collected before and during cross-clamping of the aorta as well as from 0 to 60 min and from 60 to 120 min of reperfusion. The ELF levels of several cytokines changed significantly during reperfusion. In particular, IL-6 increased more than 10-fold and IL-13 more than 5-fold during ischemia and reperfusion. Also, the venous levels of several inflammatory and anti-inflammatory cytokines increased and exhibited their highest concentration during reperfusion. Both bronchial and venous cytokine levels correlated with duration of the procedure, intensive care days, and preoperative kidney disease. Three patients suffered organ failure as a direct consequence of the procedure, and in these patients the bronchial ELF concentrations of 17 of 18 cytokines differed significantly from patients without such complications. Bronchial microdialysis is suited for continuous monitoring of inflammation during open AAA repair. The bronchial ELF cytokine levels may be useful in predicting immediate complications such as organ failure in patients undergoing vascular surgery.
主动脉手术会导致缺血再灌注损伤，引发炎症反应并常伴有并发症。血液和支气管中炎症反应的程度可能与即刻并发症的风险相关。本研究的目的是评估支气管微透析作为对支气管上皮衬液（ELF）中细胞因子进行连续监测的方法，并确定支气管ELF细胞因子水平是否反映开放腹主动脉瘤（AAA）修复过程中的缺血再灌注损伤及并发症风险。我们使用微透析测量静脉血中的细胞因子，并与血清中的细胞因子进行比较。一项前瞻性观察性研究纳入了16例计划接受择期开放AAA修复的患者。将微透析导管分别插入支气管和肘静脉。使用生物芯片磁性人细胞因子检测板测量18种细胞因子。在主动脉交叉钳夹前、钳夹期间以及再灌注的0至60分钟和60至120分钟采集样本。几种细胞因子的ELF水平在再灌注期间发生了显著变化。特别是，白细胞介素-6（IL-6）在缺血和再灌注期间增加了10倍以上，白细胞介素-13（IL-13）增加了5倍以上。此外，几种促炎和抗炎细胞因子的静脉水平在再灌注期间升高并达到最高浓度。支气管和静脉中的细胞因子水平均与手术持续时间、重症监护天数和术前肾病相关。3例患者因手术直接导致器官衰竭，在这些患者中，18种细胞因子中的17种在支气管ELF中的浓度与无此类并发症的患者有显著差异。支气管微透析适用于开放AAA修复期间炎症的连续监测。支气管ELF细胞因子水平可能有助于预测血管手术患者的即刻并发症，如器官衰竭。
