Inselmann G, Köhler K, Lange V, Silber R, Nellessen U
Medizinische Poliklinik, Universität Würzburg, Deutschland.
Cardiology. 1998;89(2):124-9. doi: 10.1159/000006767.
Myocardial injury after cardiac surgery with cardiopulmonary bypass may be related to free oxygen radical-induced lipid peroxidation. The purpose of this study was to monitor perioperative changes of cardiac troponin t and malondialdehyde as an indicator of lipid peroxidation in patients who underwent routine cardiac operation and had no signs of perioperative myocardial infarction. Patients with thoracic surgery alone served as controls. We studied 20 patients with cardiopulmonary bypass (CPB) and 9 patients with other thoracic operations. Serum troponin t, malondialdehyde, myoglobin, creatine kinase (CK) including CK-MB isoenzyme levels were monitored before CPB, immediately after cessation of CPB, 20 and 44 h after CPB. Patients with signs of myocardial infarction before or up to 44 h after surgery were excluded. Of 20 patients with CBP, 18 patients showed a significant increase of troponin t and 16 patients had elevated malondialdehyde serum levels following CPB. Troponin t serum values were raised immediately after CPB to 0.60 +/- 0.12 microg/l and increased further to 0.90 +/- 0.17 microg/l after 44 h (p < 0.005, in comparison to preoperative: 0.08 +/- 0.02 microg/l). Patients undergoing the other thoracic operations showed neither any detectable troponin t serum values nor significant changes of serum malondialdehyde during the observed period. In the CPB group serum malondialdehyde peaked immediately after CPB to 98 +/- 9 nmol/g albumin (p < 0.005) and returned to preoperative levels (63 +/- 3 nmol/g albumin) within 20 h (60 +/- 3 nmol/g albumin). Individual maximal troponin t serum levels did not correlate with individual maximal serum malondialdehyde levels. The observed increase of troponin t levels had no influence on patients' outcome followed up for 18 months. The results demonstrate that troponin t and lipid peroxidation increase during uncomplicated cardiac surgery in patients without signs of myocardial infarction. Following uncomplicated cardiac surgery, a moderate increase of cardiac troponin t may not reflect severe cardiac injury.
体外循环心脏手术后的心肌损伤可能与游离氧自由基诱导的脂质过氧化有关。本研究的目的是监测接受常规心脏手术且无围手术期心肌梗死迹象患者的心肌肌钙蛋白T和丙二醛（作为脂质过氧化指标）的围手术期变化。仅接受胸外科手术的患者作为对照。我们研究了20例接受体外循环（CPB）的患者和9例接受其他胸科手术的患者。在CPB前、CPB停止后即刻、CPB后20小时和44小时监测血清肌钙蛋白T、丙二醛、肌红蛋白、肌酸激酶（CK）包括CK-MB同工酶水平。排除术前或术后44小时内有心肌梗死迹象的患者。在20例接受CPB的患者中，18例患者CPB后肌钙蛋白T显著升高，16例患者CPB后血清丙二醛水平升高。CPB后即刻肌钙蛋白T血清值升至0.60±0.12μg/l，44小时后进一步升至0.90±0.17μg/l（与术前相比：0.08±0.02μg/l，p<0.005）。接受其他胸科手术的患者在观察期内既未检测到肌钙蛋白T血清值，血清丙二醛也无显著变化。在CPB组，血清丙二醛在CPB后即刻达到峰值98±9nmol/g白蛋白（p<0.005），并在20小时内恢复到术前水平（63±3nmol/g白蛋白）（60±3nmol/g白蛋白）。个体肌钙蛋白T血清最高水平与个体血清丙二醛最高水平不相关。观察到的肌钙蛋白T水平升高对随访18个月的患者预后无影响。结果表明，在无心肌梗死迹象的患者进行非复杂性心脏手术期间，肌钙蛋白T和脂质过氧化增加。非复杂性心脏手术后，心肌肌钙蛋白T的适度升高可能并不反映严重的心脏损伤。
