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肠道屏障功能障碍参与A型主动脉夹层全身炎症反应和肺损伤的发生发展：一项病例对照研究。

Intestinal barrier dysfunction is involved in the development of systemic inflammatory responses and lung injury in type A aortic dissection: a case-control study.

作者信息

Li Jianrong, Zheng Jun, Jin Xiufeng, Zhu Kai, Wang Xiaolong, Zhang Hongjia

机构信息

Department of Cardiovascular Surgery, Beijing Engineering Research Center for Vascular Prostheses, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.

出版信息

J Thorac Dis. 2022 Sep;14(9):3552-3564. doi: 10.21037/jtd-22-1122.

DOI:10.21037/jtd-22-1122

PMID:36245611

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9562527/

Abstract

BACKGROUND

The definite pathogenesis of lung injury complicated by type A aortic dissection (TAAD) remains unclear. In this paper, we investigated the relationship between intestinal injury, lung injury, and systemic inflammatory responses, with the aim of exploring the mechanism underlying intestinal injury and its impact on systemic inflammatory responses and lung injury in patients with TAAD.

METHODS

Patients with TAAD (n=36) and those with aortic root aneurysm (ARA) (n=30) were compared. TAAD patients were younger and had higher creatinine (Cr) than ARA patients. White blood cell (WBC) count, neutrophil count, neutrophil percentage, interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), C-reactive protein (CRP), histamine (HIS) levels, PaO-FiO ratio, diamine oxidase (DAO), intestinal fatty acid binding protein (iFABP), and peptidoglycan (PGN) were measured using the same laboratory methods between the two groups.

RESULTS

Increased WBC [(9.70±4.05)×10/L (5.88±1.2)×10/L, P<0.001], neutrophil [(7.65±4.27)×10/L (3.40±0.97)×10/L, P<0.001], neutrophil percentage [(74.73±13.42)% . (57.67±9.45)%, P<0.001], IL-6 (37.48±4.87 . 20.90±0.92 pg/mL, P<0.001), IL-8 (97.15±9.11 . 69.46±3.17 pg/mL, P<0.001), TNF-α (71.32±10.35 . 33.90±2.27 pg/mL, P<0.001), CRP (10.67±1.62 4.43±0.26 µg/mL, P<0.001), HIS (13.29±1.88 . 7.63±0.58 ng/mL, P<0.001), DAO (24.94±4.72 . 10.92±2.44 U/L, P<0.001), iFABP (879.01±190.12 206.35±42.20 pg/mL, P<0.001), and PGN (31.10±5.51 12.52±2.20 ng/mL, P<0.001) and decreased PaO-FiO ratio (365.35±146.47 . 447.86±70.80 mmHg, P=0.01) were detected in TAAD group relative to ARA group. In TAAD group, positive correlations were detected between DAO and inflammatory cytokines [IL-6 (r=0.56, P<0.001), IL-8 (r=0.61, P<0.001), TNF-α (r=0.71, P<0.001), and CRP (r=0.68, P<0.001)], between iFABP and inflammatory cytokines [IL-6 (r=0.72, P<0.001), IL-8 (r=0.71, P<0.001), TNF-α (r=0.90, P<0.001), and CRP (r=0.89, P<0.001)], between DAO and PGN (r=0.52, P<0.001), between iFABP and PGN (r=0.74, P<0.001), between PGN and inflammatory cytokines [IL-6 (r=0.85, P<0.001), IL-8 (r=0.44, P<0.001), TNF-α (r=0.61, P<0.001), and CRP (r=0.73, P<0.001)]. In acute TAAD subgroup, PGN and PaO-FiO ratio were negatively correlated (r=-0.50, P=0.036).

CONCLUSIONS

Systemic inflammatory responses in TAAD patients may lead to lung and intestine injury, and the latter may be involved in the development of systemic inflammatory responses and lung injury in these patients.

摘要

背景

A型主动脉夹层（TAAD）并发肺损伤的确切发病机制尚不清楚。本文研究了肠损伤、肺损伤与全身炎症反应之间的关系，旨在探讨TAAD患者肠损伤的机制及其对全身炎症反应和肺损伤的影响。

方法

比较TAAD患者（n = 36）和主动脉根部瘤（ARA）患者（n = 30）。TAAD患者比ARA患者更年轻，肌酐（Cr）水平更高。采用相同实验室方法检测两组患者的白细胞（WBC）计数、中性粒细胞计数、中性粒细胞百分比、白细胞介素（IL）-6、IL-8、肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）、组胺（HIS）水平、氧合指数（PaO-FiO）、二胺氧化酶（DAO）、肠脂肪酸结合蛋白（iFABP）和肽聚糖（PGN）。

结果

与ARA组相比，TAAD组的WBC[（9.70±4.05）×10⁹/L 对（5.88±1.2）×10⁹/L，P<0.001]、中性粒细胞[（7.65±4.27）×10⁹/L 对（3.40±0.97）×10⁹/L，P<0.001]、中性粒细胞百分比[（74.73±13.42）% 对（57.67±9.45）%，P<0.001]、IL-6（37.48±4.87 对 20.90±0.92 pg/mL，P<0.001）、IL-8（97.15±9.11 对 69.46±3.17 pg/mL，P<0.001）、TNF-α（71.32±10.35 对 33.90±2.27 pg/mL，P<0.001）、CRP（10.67±1.62 对 4.43±0.26 µg/mL，P<0.001）、HIS（13.29±1.88 对 7.63±0.58 ng/mL，P<0.001）、DAO（24.94±4.72 对 10.92±2.44 U/L，P<0.001）、iFABP（879.01±190.12 对 206.35±42.20 pg/mL，P<0.001）和PGN（31.10±5.51 对 12.52±2.20 ng/mL，P<0.001）升高，PaO-FiO比值降低（365.35±146.47 对 447.86±70.80 mmHg，P = 0.01）。在TAAD组中，DAO与炎症细胞因子[IL-6（r = 0.56，P<0.001）、IL-δ（r = 0.61，P<0.001）、TNF-α（r = 0.71，P<0.001）和CRP（r = 0.68，P<0.001）]之间、iFABP与炎症细胞因子[IL-6（r = 0.72，P<0.001）、IL-8（r = 0.71，P<0.001）、TNF-α（r = 0.90，P<0.001）和CRP（r = 0.89，P<0.001）]之间、DAO与PGN（r = 0.52，P<0.001）之间、iFABP与PGN（r = 0.74，P<0.001）之间、PGN与炎症细胞因子[IL-6（r = 0.85，P<0.001）、IL-8（r = 0.44，P<0.001）、TNF-α（r = 0.61，P<0.001）和CRP（r = 0.73，P<0.001）]之间均检测到正相关。在急性TAAD亚组中，PGN与PaO-FiO比值呈负相关（r = -0.50，P = 0.036）。