Lingel Maximilian P, Haus Moritz, Paschke Lukas, Foltan Maik, Lubnow Matthias, Gruber Michael, Krenkel Lars, Lehle Karla
Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Artif Organs. 2023 Nov;47(11):1720-1731. doi: 10.1111/aor.14616. Epub 2023 Aug 1.
Thrombosis remains a critical complication during venovenous extracorporeal membrane oxygenation (VV ECMO). The involvement of neutrophil extracellular traps (NETs) in thrombogenesis has to be discussed. The aim was to verify NETs in the form of cell-free DNA (cfDNA) in the plasma of patients during ECMO.
A fluorescent DNA-binding dye (QuantifFluor®, Promega) was used to detect cell-free DNA in plasma samples. cfDNA concentrations from volunteers (n = 21) and patients (n = 9) were compared and correlated with clinical/technical data before/during support, ECMO end and time of a system exchange.
Before ECMO, patients with a median (IQR) age of 59 (51/63) years, SOFA score of 11 (10/15), and ECMO run time of 9.0 (7.0/19.5) days presented significantly higher levels of cfDNA compared to volunteers (6.4 (5.8/7.9) ng/μL vs. 5.9 (5.4/6.3) ng/μL; p = 0.044). Within 2 days after ECMO start, cfDNA, inflammatory, and hemolysis parameters remained unchanged, while platelets decreased (p = 0.005). After ECMO removal at the end of therapy, cfDNA, inflammation, and coagulation data (except antithrombin III) remained unchanged. The renewal of a system resulted in known alterations in fibrinogen, d-dimers, and platelets, while cfDNA remained unchanged.
Detection of cfDNA in plasma of ECMO patients was not an indicator of acute and circuit-induced thrombogenesis.
在静脉-静脉体外膜肺氧合（VV ECMO）期间，血栓形成仍然是一种严重的并发症。中性粒细胞胞外陷阱（NETs）在血栓形成中的作用有待探讨。目的是验证ECMO期间患者血浆中无细胞DNA（cfDNA）形式的NETs。
使用荧光DNA结合染料（QuantifFluor®，Promega）检测血浆样本中的无细胞DNA。比较了志愿者（n = 21）和患者（n = 9）的cfDNA浓度，并将其与支持前/期间、ECMO结束时和系统更换时间的临床/技术数据相关联。
在ECMO之前，中位（IQR）年龄为59（51/63）岁、序贯器官衰竭评估（SOFA）评分11（10/15）、ECMO运行时间9.0（7.0/19.5）天的患者与志愿者相比，cfDNA水平显著更高（6.4（5.8/7.9）ng/μL对5.9（5.4/6.3）ng/μL；p = 0.044）。在ECMO开始后2天内，cfDNA、炎症和溶血参数保持不变，而血小板减少（p = 0.005）。治疗结束时移除ECMO后，cfDNA、炎症和凝血数据（抗凝血酶III除外）保持不变。系统更换导致纤维蛋白原、D-二聚体和血小板出现已知变化，而cfDNA保持不变。
检测ECMO患者血浆中的cfDNA并非急性和回路诱导血栓形成的指标。
