Dohle Daniel-Sebastian, Bestendonk Carolin, Petrat Frank, Tsagakis Konstantinos, Wang Meng, Strucksberg Karl-Heinz, Canbay Ali, Jakob Heinz, de Groot Herbert
Department of Cardiothoracic and Vascular Surgery, University Medical Center, Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany.
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Innov Surg Sci. 2018 Nov 30;3(4):277-283. doi: 10.1515/iss-2018-0035. eCollection 2018 Dec.
Mesenteric ischemia (MESI) is a rare but often fatal complication in patients after cardiac surgery. Non-specific clinical symptoms and lack of specific laboratory parameters complicate the diagnosis. We evaluated potential serum markers for MESI in cardiac surgery patients.
Between March and October 2012, serial serum samples of 567 elective cardiac surgery patients were collected 1, 24, and 48 h after the operation, and concentrations of potential markers for MESI [α-glutathione-S-transferase (αGST), intestinal fatty-acid-binding protein (iFABP), and D-lactate] were measured retrospectively. In patients requiring laparotomy, blood samples obtained 72, 48, 24, and 12 h before the laparotomy were additionally measured and compared to all other patients (control group).
Laparotomy was performed in 18 patients at 11±7 days after cardiac surgery. MESI was found in 9/18 patients. Already 1 h after cardiac surgery, the serum concentrations of D-lactate (37±18 vs. 25±20 nmol/mL, p<0.01) and αGST (82±126 vs. 727±1382 μg/L, p<0.01) in patients undergoing laparotomy were increased compared to the control group. Between patients with and without MESI, differences were only found for iFABP 24 h after cardiac surgery (1.1±0.4 vs. 2.9±0.6 ng/mL, p=0.04) and up to 72 h before laparotomy (0.56±0.72 vs. 2.51±1.96 ng/mL, p=0.01).
D-lactate and αGST were early markers for gastrointestinal complications after cardiac surgery. Before laparotomy, lowered iFABP levels indicated MESI. Routinely used, these markers can help identify patients with gastrointestinal complications after cardiac surgery early, and might be useful for the evaluation of new therapeutic or preventive strategies.
肠系膜缺血（MESI）是心脏手术后患者中一种罕见但往往致命的并发症。非特异性临床症状和缺乏特异性实验室指标使诊断复杂化。我们评估了心脏手术患者中MESI的潜在血清标志物。
在2012年3月至10月期间，收集了567例择期心脏手术患者术后1小时、24小时和48小时的系列血清样本，并回顾性测量了MESI的潜在标志物[α-谷胱甘肽-S-转移酶（αGST）、肠脂肪酸结合蛋白（iFABP）和D-乳酸]的浓度。对于需要剖腹手术的患者，还测量了剖腹手术前72小时、48小时、24小时和12小时采集的血样，并与所有其他患者（对照组）进行比较。
18例患者在心脏手术后11±7天进行了剖腹手术。18例患者中有9例发现MESI。心脏手术后仅1小时，剖腹手术患者的血清D-乳酸浓度（37±18 vs. 25±20 nmol/mL，p<0.01）和αGST浓度（82±126 vs. 727±1382 μg/L，p<0.01）就高于对照组。在有和没有MESI的患者之间，仅在心脏手术后24小时（1.1±0.4 vs. 2.9±0.6 ng/mL，p=0.04）以及剖腹手术前长达72小时（0.56±0.72 vs. 2.51±1.96 ng/mL，p=0.01）发现iFABP存在差异。
D-乳酸和αGST是心脏手术后胃肠道并发症的早期标志物。在剖腹手术前，iFABP水平降低提示MESI。常规使用这些标志物有助于早期识别心脏手术后有胃肠道并发症的患者，可能对评估新的治疗或预防策略有用。
