Sigler Matthias, Rouatbi Hatem, Vazquez-Jimenez Jaime, Seghaye Marie-Christine
Pediatric Cardiology, Intensive Care Medicine and Neonatology, Georg-August Universität, Robert-Koch-Str. 40, D-37075, Göttingen, Germany.
Department of Pediatrics and Pediatric Cardiology, University Hospital Liège, Liège, Belgium.
Mol Cell Pediatr. 2022 Mar 20;9(1):5. doi: 10.1186/s40348-022-00138-y.
To examine whether uni-ventricular palliation (UVP) and bi-ventricular repair (BVR) result in a different pattern of systemic inflammatory response to pediatric cardiac surgery with extra-corporeal circulation (ECC).
In 20 children (median age 39.5 months) undergoing either UVP (n = 12) or BVR (n = 8), plasma levels of the inflammatory cytokines TNF-α, IL-6, IL-10, and IL-12 and of procalcitonin (PCT), were measured before, during and after open cardiac surgery up to postoperative day (POD) 10.
Epidemiologic, operative- and outcome variables were similar in both groups but post-operative central venous pressure that was higher in UVP. In the whole cohort, the inflammatory response was characterized by an early important, significant and parallel increase of IL-6 and IL-10 that reached their peak values either at the end of ECC (IL-10) or 4 h postoperatively (IL-6), respectively and by a significant and parallel decrease of TNF-α and IL-12 levels after connection to ECC, followed by a bi-phasic significant increase with a first peak 4 h after ECC and a second at POD 10, respectively. Patients after UVP showed a shift of the cytokine balance with lower IL-6- (p = 0.01) after connection to ECC, lower early post-operative TNF-α - (p = 0.02) and IL-12- (p = 0.04) concentrations and lower TNF-α/IL-10-ratio (p = 0.03) as compared with patients with BVR. Levels of PCT were similar in both groups.
UVP is associated with an anti-inflammatory shift of the inflammatory response to cardiac surgery that might be related to the particular hemodynamic situation of patients with UVP.
探讨单心室姑息治疗（UVP）和双心室修复（BVR）对小儿体外循环心脏手术全身炎症反应模式的影响是否不同。
选取20例接受UVP（n = 12）或BVR（n = 8）的儿童（中位年龄39.5个月），在心脏直视手术前、术中及术后直至术后第10天（POD）10，测量炎症细胞因子TNF-α、IL-6、IL-10、IL-12以及降钙素原（PCT）的血浆水平。
两组的流行病学、手术及结局变量相似，但UVP组术后中心静脉压较高。在整个队列中，炎症反应的特征是IL-6和IL-10早期显著且平行升高，分别在体外循环结束时（IL-10）或术后4小时（IL-6）达到峰值，连接体外循环后TNF-α和IL-水平显著且平行下降，随后出现双相显著升高，第一个峰值在体外循环后4小时，第二个峰值在术后第10天。与BVR患者相比，UVP患者在连接体外循环后细胞因子平衡发生变化，IL-6水平较低（p = 0.01），术后早期TNF-α（p = 0.02）和IL-12（p = 0.04）浓度较低，TNF-α/IL-10比值较低（p = 0.03）。两组PCT水平相似。
UVP与心脏手术炎症反应的抗炎转变有关，这可能与UVP患者的特殊血流动力学情况有关。
