Jeong Seong Cheol, Kim Jae Jun, Kim Yong Hwan, Kim In Sub, Han Jung Wook
Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul, Gyeonggi-do, Korea.
J Thorac Dis. 2019 Oct;11(10):4349-4356. doi: 10.21037/jtd.2019.09.49.
In previous study, we found elevated serum total lactate dehydrogenase (LDH) before correction of pectus excavatum and a decrease in total LDH after the deformity correction. In the present study, we analyzed total LDH activity and its isoenzyme patterns to investigate the causes of these laboratory findings in patients with pectus excavatum.
Between March 2014 to December 2018, 85 patients with pectus excavatum who had undergone the Nuss procedure (NP) and bar removal (BR) were included into this study. We analyzed (I) total LDH and its isoenzyme patterns before the correction, (II) relationships of total LDH and its isoenzymes with age at time of NP, sex, severity of pectus excavatum, and pectus morphology types, and (III) post-corrective changes.
The mean age of the patients was 13.6 (±6.5) years at the age of NP and the mean interval between NP and BR was 2.2 (±0.42) years. Seventy-one males and 14 females were included. The pectus types included 54 symmetric and 31 asymmetric cases. The mean Haller index before NP and BR were 3.8±1.45 and 2.7±0.4, respectively. The mean of total LDH before NP (pre-correction) and BR (post-correction) were 404.2±80.8 and 369.2±79.3 IU/L, respectively. Before correction, total LDH was significantly higher than normal values, irrespective of age [the young group (<10 years old), P=0.006, and the old group (≥10 years old), P<0.001]. The proportion of LDH5 was significantly higher than that of LDH4 (P<0.001). Total serum LDH was significantly associated with age at time of NP and Haller index (P<0.001 and P=0.030). There was no significant correlation between severity and total LDH. However, the value of only LDH5 among all isoenzymes had a significant positive correlation with severity (P=0.006) and the proportion of only LDH5 in the severe group was significantly higher (P=0.003). After correction, proportions of each isoenzyme were all within the reference range, however, there were significant decreases in values of LDH1-LDH4, except LDH5 (P=0.020, P<0.001, P<0.001, and P=0.029).
This study shows that pectus excavatum is a muscular disease entity and that laboratory findings are associated with compression of internal organs, which was explained by post-corrective changes in LDH activity and its isoenzyme patterns. This study will provide a deeper and wider comprehension of pectus excavatum.
在先前的研究中，我们发现漏斗胸矫正术前血清总乳酸脱氢酶（LDH）升高，而畸形矫正后总LDH降低。在本研究中，我们分析了总LDH活性及其同工酶谱，以探究漏斗胸患者这些实验室检查结果的原因。
2014年3月至2018年12月期间，85例接受了Nuss手术（NP）及取出钢板（BR）的漏斗胸患者纳入本研究。我们分析了：（I）矫正前的总LDH及其同工酶谱；（II）总LDH及其同工酶与NP时的年龄、性别、漏斗胸严重程度及胸廓形态类型的关系；（III）矫正后的变化。
患者接受NP时的平均年龄为13.6（±6.5）岁，NP与BR之间的平均间隔为2.2（±0.42）年。其中男性71例，女性14例。胸廓类型包括54例对称型和31例不对称型。NP和BR前的平均Haller指数分别为3.8±1.45和2.7±0.4。NP（矫正前）和BR（矫正后）时的总LDH平均值分别为404.2±80.8和369.2±79.3 IU/L。矫正前，无论年龄大小，总LDH均显著高于正常值[年轻组（<10岁），P = 0.006；老年组（≥10岁），P<0.001]。LDH5的比例显著高于LDH4（P<0.001）。血清总LDH与NP时的年龄及Haller指数显著相关（P<0.001和P = 0.030）。严重程度与总LDH之间无显著相关性。然而，所有同工酶中只有LDH5的值与严重程度呈显著正相关（P = 0.006），且严重组中仅LDH5的比例显著更高（P = 0.003）。矫正后，各同工酶的比例均在参考范围内，然而，LDH1 - LDH4的值均显著下降，LDH5除外（P = 0.020、P<0.001、P<0.001和P = 0.029）。
本研究表明，漏斗胸是一种肌肉疾病实体，实验室检查结果与内脏受压有关，这可通过LDH活性及其同工酶谱的矫正后变化来解释。本研究将为漏斗胸提供更深入、更广泛的理解。
