儿童体外循环术后细胞外组蛋白的变化及临床意义

The post-operative change and clinical significance of extracellular histones after cardiopulmonary bypass in children

目的研究先天性心脏病患儿在体外循环下行纠治术术后细胞外组蛋白的变化及其临床意义。方法分别收集16例非紫绀型(A组)和32例紫绀型(B组)患儿在术前(T0)、术后0 h(T1)、4 h(T2)、24 h(T3)、48 h(T4)和72 h(T5)的外周血,检测血清组蛋白、降钙素原(PCT)及C反应蛋白(CRP)水平,同时记录术中体外循环时间、主动脉阻断时间,术后机械通气时间、重症监护室时间等临床参数。结果两组细胞外组蛋白、PCT和CRP术后均较术前显著升高,分别于T1、T3和T4达到峰值,且A、B两组各指标峰值有统计学差异。线性回归分析示,两组细胞外组蛋白峰值与PCT和CRP峰值及临床参数之间有统计学相关性。ROC曲线分析示T1细胞外组蛋白水平对术后抗生素的应用及ICU时间具有预测价值。结论术后细胞外组蛋白较PCT和CRP更早达到峰值,且其峰值与病情的严重程度相关,可作为儿童体外循环术后的早期临床预后参考指标。

Objective To investigate the post-operative change of extracellular histones and its clinical significance after car-diopulmonary bypass（CPB） in children with congenital heart disease（CHD）.Methods Sixteen children with non-cyanosis CHD（Group A） and thirty-two children with cyanosis CHD（Group B）, undergoing corrective procedures with CPB, were prospectivelyenrolled in this study. Extracellular histones, procalcitonin（PCT） and C-reactive protein（CRP） were measured at pre-OP（opera-tive）（T0）, post-OP hour 0（T1）, post-OP hour 4（T2）, post-OP hour 24（T3）,post-OP hour 48（T4） and post-OP hour 72（T5）. The relationships between histones and PCT, CRP as well as clinical parameters were analyzed.Results In both groups, theextracellular histones, PCT and CRP levels increased significantly post-OP, and peaked at T1, T3 and T4 respectively. In each group,the highesthistones level was correlated with the peak PCT and CRP levels as well as the ventilation time and ICU stay time. Receiveroperating characteristic（ROC） curves analysis showed that, the peak histones level had predictive values in antibiotic use and pro-longed ICU stay（〉3 days） postoperatively.Conclusion The extracellular histones reached peak level earlier than PCT and CRP, andthe peak histones level had correlation with the disease severity postoperatively. The extracellular histones level at post-OP hour 0 canbe potentially used as a rapid prognostic indicator in children after cardiac surgery with CPB.