体外循环心脏手术后血浆不同粒径循环微粒含量变化及其与正性肌力药物剂量的相关性

The correlation between concentrations of size-dependent circulating microparticles from patients and the dose of positive inotropic medicine undergoing cardiac surgery with cardiopulmonary bypass

目的通过分析体外循环(CPB)心脏手术前、后不同粒径范围循环微粒(MPs)的含量变化,及其与术后正性肌力药物剂量的相关性,研究MPs与术后心功能的关系。方法收集103例行体外循环下心内直视手术的患者为手术组,分别采集术前、术后12 h、术后72 h静脉血标本;56名同期经过年龄、性别匹配的健康志愿者为正常对照组。通过梯度离心分离MPs,用纳米颗粒跟踪分析法检测各组MPs含量。根据MPs粒径大小将MPs分成不同亚组,比较各组间MPs的含量变化,分析不同粒径范围MPs与术后正性肌力药物剂量的相关性。结果手术组术前、术后血浆MPs含量均较正常对照组升高(P<0.05);手术组不同时间点MPs总含量变化差异无统计学意义(P>0.05)。根据粒径大小将MPs分成0~100、100~200、200~300、300~1 000 nm共4个亚组,术后12 h和术后72 h 0~100 nm MPs含量较术前减小(P<0.05),200~300 nm MPs含量较术前增加(P<0.05)。术后12 h 0~100 nm MPs含量与氨基末端脑钠肽前体(NT-proBNP)水平、多巴胺、去甲肾上腺素、米力农剂量呈负相关(P<0.05),200~300 nm MPs含量与NT-proBNP呈正相关(P<0.05);术后72 h 0~100 nm MPs含量与NT-proBNP呈负相关(P<0.05),200~300 nm MPs含量与多巴酚丁胺剂量呈负相关(P<0.05)。结论 CPB辅助心脏外科手术后,不同粒径范围的MPs与术后正性肌力药物剂量有相关性,提示其与术后心功能存在一定的关系。因此,检测术后不同时间不同粒径范围的MPs对临床有指导意义。

Aim This study analyzed the relationship between the concentration of circulating microparticles(MPs)with different diameters and the application of positive inotropic drugs in the patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).It aims to find out the effects of MPs on the postoperative cardiac function.Methods 103 patients undergoing cardiac surgery with CPB were enrolled.Age and gender matched 56 healthy subjects were recruited as control group.The blood was collected from healthy subjects and patients before(pre-op)and after operation 12 h(post-op 12 h)and 72 h(post-op 72 h).The MPs were isolated by differential centrifugation.The concentration and size distribution of MPs were detected by nanoparticle tracking analysis system.MPs were divided into different subgroups according to the size of MPs.The clinical data were collected and the correlation analysis was performed between the MPs and the clinical data.Results The level of MPs was increased in patients before and after surgery compared with healthy subjects(P<0.05).There was no significant difference of the concentration of MPs in the surgery group among the different time points(pre-op,post-op 12 h and post-op 72 h).The MPs were divided into four groups according to the diameter(0~100 nm,100~200 nm,200~300 nm and 300~400 nm).The levels of“100~200 nm”MPs were decreased in post-op 12 h and post-op 72 h groups compared with pre-op group,but the levels of“200~300 nm”MPs were increased after operation(P<0.05).In post-op 12 h group,the concentration of“0~100 nm”MPs was negatively correlated with N terminal pro B type natriuretic peptide(NT-proBNP),dopamine,norepinephrine and milrinone and the level of“200~300 nm”MPs was positively correlated with NT-proBNP(P<0.05).In post-op 72 h group,the level of“0~100 nm”MPs was negatively correlated with NT-proBNP(P<0.05)and the concentration of“200~300 nm”MPs was negatively correlated with dobutamine(P<0.05).Conclusions After CPB assisted cardiac surgery,MPs with different particle size range was correlated with postoperative positive inotropic drug dosage,suggesting that there was a certain relationship between MPs and postoperative cardiac function.The concentration of MPs in different size may be used to reflect the cardiac function after CPB.