中性粒细胞弹性蛋白酶抑制剂西维来司他可减轻体外循环患者的急性肺损伤。
The neutrophil elastase inhibitor, sivelestat, attenuates acute lung injury in patients with cardiopulmonary bypass.
作者信息
Pan Tuo, Tuoerxun Tayierjiang, Chen Xi, Yang Cheng-Jin, Jiang Chen-Yu, Zhu Yi-Fan, Li Ze-Shi, Jiang Xin-Yi, Zhang Hai-Tao, Zhang He, Wang Ya-Peng, Chen Wei, Lu Li-Chong, Ge Min, Cheng Yong-Qing, Wang Dong-Jin, Zhou Qing
机构信息
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, China.
出版信息
Front Immunol. 2023 Jan 24;14:1082830. doi: 10.3389/fimmu.2023.1082830. eCollection 2023.
BACKGROUND
The sivelestat is a neutrophil elastase inhibitor thought to have an effect against acute lung injury (ALI) in patients after scheduled cardiac surgery. However, the beneficial effect of sivelestat in patients undergoing emergent cardiovascular surgery remains unclear. We aim to evaluate the effect of sivelestat on pulmonary protection in patients with ALI after emergent cardiovascular surgery.
METHODS
Firstly, a case-control study in 665 patients undergoing emergent cardiovascular surgery from January 1, 2020 to October 26, 2022 was performed. 52 patients who received sivelestat (0.2mg/kg/h for 3 days) and 613 age- and sex-matched controls. Secondly, a propensity-score matched cohort (sivelestat vs control: 50 vs 50) was performed in these 665 patients. The primary outcome was a composite of adverse outcomes, including 30-day mortality, ECMO, continuous renal replacement therapy (CRRT) and IABP, etc. The secondary outcome included pneumonia, ventricular arrhythmias and mechanical ventilation time, etc.
RESULTS
In propensity-matched patients, the 30-day mortality (16% vs 24%, P=0.32), stroke (2% vs 8%, P=0.17), ECMO(6% vs 10%, P=0.46), IABP(4% vs 8%, P=0.40) and CRRT(8% vs 20%, P=0.08) had no differences between sivelestat and control group; sivelestat could significantly decrease pneumonia (40% vs 62%, P=0.03), mechanical ventilation time (median: 96hours, IQR:72-120hours vs median:148hours, IQR:110-186hours, P<0.01), bilateral pulmonary infiltrates (P<0.01), oxygen index (P<0.01), interleukin-6(P=0.02), procalcitonin(P<0.01) and C-reactive protein(P<0.01).
CONCLUSION
Administration of sivelestat might improve postoperative outcomes in patients with ALI after emergent cardiovascular surgery. Our results show that sivelestat may be considered to protect pulmonary function against inflammatory injury by CPB.
REGISTRATION
http://www.chictr.org.cn/showproj.aspx?proj=166643, identifier ChiCTR2200059102.
背景
西维来司他是一种中性粒细胞弹性蛋白酶抑制剂，被认为对心脏直视手术后患者的急性肺损伤（ALI）有作用。然而，西维来司他在接受急诊心血管手术患者中的有益作用仍不清楚。我们旨在评估西维来司他对急诊心血管手术后ALI患者肺保护的效果。
方法
首先，对2020年1月1日至2022年10月26日期间接受急诊心血管手术的665例患者进行病例对照研究。52例接受西维来司他治疗（0.2mg/kg/h，持续3天）的患者和613例年龄及性别匹配的对照。其次，在这665例患者中进行倾向评分匹配队列研究（西维来司他组与对照组：50例对50例）。主要结局是不良结局的复合指标，包括30天死亡率、体外膜肺氧合（ECMO）、持续肾脏替代治疗（CRRT）和主动脉内球囊反搏（IABP）等。次要结局包括肺炎、室性心律失常和机械通气时间等。
结果
在倾向评分匹配的患者中，西维来司他组与对照组在30天死亡率（16%对24%，P = 0.32）、中风（2%对8%，P = 0.17）、ECMO（6%对10%，P = 0.46）、IABP（4%对8%，P = 0.40）和CRRT（8%对20%，P = 0.08）方面无差异；西维来司他可显著降低肺炎发生率（40%对62%，P = 0.03）、机械通气时间（中位数：96小时，四分位数间距：72 - 120小时对中位数：148小时，四分位数间距：110 - 186小时，P < 0.01）、双侧肺浸润（P < 0.01）、氧合指数（P < 0.01）、白细胞介素 - 6（P = 0.02）、降钙素原（P < 0.01）和C反应蛋白（P < 0.01）。
结论
给予西维来司他可能改善急诊心血管手术后ALI患者的术后结局。我们的结果表明，西维来司他可考虑用于保护肺功能免受体外循环引起的炎性损伤。
注册信息
http://www.chictr.org.cn/showproj.aspx?proj=166643，标识符ChiCTR2200059102
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