有和无肺损伤的心脏手术患者的白细胞和血小板激活：一项前瞻性队列研究。
Leucocyte and platelet activation in cardiac surgery patients with and without lung injury: A prospective cohort study.
作者信息
Van Paassen Judith, De Graaf-Dijkstra Alice, Brunsveld-Reinders Anja H, De Jonge Evert, Klautz Robert J M, Tsonaka Roula, Zwaginga Jaap Jan, Arbous M Sesmu
机构信息
Leiden University Medical Center, Department of Intensive Care, Netherlands.
Center for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands.
出版信息
Interdiscip Cardiovasc Thorac Surg. 2023 May 4;36(5). doi: 10.1093/icvts/ivad062.
OBJECTIONS
Development of acute lung injury after cardiac surgery is associated with an unfavourable outcome. Acute respiratory distress syndrome in general is, besides cytokine and interleukin activation, associated with activation of platelets, monocytes and neutrophils. In relation to pulmonary outcome after cardiac surgery, leucocyte and platelet activation is described in animal studies only. Therefore, we explored the perioperative time course of platelet and leucocyte activation in cardiac surgery and related these findings to acute lung injury assessed via PaO2/FiO2 (P/F) ratio measurements.
METHODS
A prospective cohort study was performed, including 80 cardiac surgery patients. At five time points, blood samples were directly assessed by flow cytometry. For time course analyses in low (< 200) versus high (≥200) P/F ratio groups, repeated measurement techniques with linear mixed models were used.
RESULTS
Already before the start of the operation, platelet activatability (P = 0.003 for thrombin receptor-activator peptide and P = 0.017 for adenosine diphosphate) was higher, and the expression of neutrophil activation markers was lower (CD18/CD11; P = 0.001, CD62L; P = 0.013) in the low P/F group. After correction for these baseline differences, the peri- and postoperative thrombin receptor-activator peptide-induced thrombocyte activatability was decreased in the low P/F ratio group (P = 0.008), and a changed pattern of neutrophil activation markers was observed.
CONCLUSIONS
Prior to surgery, an upregulated inflammatory state with higher platelet activatability and indications for higher neutrophil turnover were demonstrated in cardiac surgery patients who developed lung injury. It is difficult to distinguish whether these factors are mediators or are also aetiologically related to the development of lung injury after cardiac surgery. Further research is warranted.
TRIAL REGISTRATION
Clinical Registration number: ICTRP: NTR 5314, 26-05-2015.
目的
心脏手术后急性肺损伤的发生与不良预后相关。一般来说，急性呼吸窘迫综合征除了与细胞因子和白细胞介素激活有关外，还与血小板、单核细胞和中性粒细胞的激活有关。关于心脏手术后的肺部预后，白细胞和血小板激活仅在动物研究中有描述。因此，我们探讨了心脏手术中血小板和白细胞激活的围手术期时间进程，并将这些发现与通过动脉血氧分压/吸入氧分数（P/F）比值测量评估的急性肺损伤相关联。
方法
进行了一项前瞻性队列研究，纳入80例心脏手术患者。在五个时间点，通过流式细胞术直接评估血样。对于低（<200）与高（≥200）P/F比值组的时间进程分析，使用了线性混合模型的重复测量技术。
结果
在手术开始前，低P/F组的血小板激活能力就较高（凝血酶受体激活肽P = 0.003，二磷酸腺苷P = 0.017），中性粒细胞激活标志物的表达较低（CD18/CD11；P = 0.001，CD62L；P = 0.013）。在校正这些基线差异后，低P/F比值组的围手术期和术后凝血酶受体激活肽诱导的血小板激活能力降低（P = 0.008），并且观察到中性粒细胞激活标志物的模式发生了变化。
结论
在发生肺损伤的心脏手术患者中，术前存在炎症状态上调，血小板激活能力较高，中性粒细胞更新增加。很难区分这些因素是肺损伤的介质还是与心脏手术后肺损伤的病因也相关。有必要进行进一步研究。
试验注册
临床注册号：ICTRP：NTR 5314，2015年5月26日。
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