先天性心脏病开胸手术和介入治疗血浆炎性因子及神经损伤标志物的变化

The changes of serum inflammatory factors and neuro-injury biomarkers between open-heart cardiac surgery and intervention therapy in congenital heart disease

目的观察和对比先天性心脏病开胸心内直视手术及介入治疗血浆中肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6和C反应蛋白(CRP)以及神经损伤标志物神经元特异性烯醇化酶(NSE)和S100β的表达变化。方法择期行先天性心脏病手术治疗的儿童患者36例,18例行全麻开胸心肺转流下行直视手术,18例行全麻下经导管介入封堵术,分别于术前(T0)、术后即刻(T1)、术后6 h(T2)、12 h(T3)和24 h(T4)抽取血浆,两组标本均采用酶联免疫吸附实验(ELISA)测定TNF-α、IL-6、CRP、NSE和S100β的表达情况。结果开胸组患者血浆TNF-α、IL-6及CRP在T1~T4较T0时显著升高(P<0.05),且其在T1~T4时的表达明显高于介入组(P<0.05)。除T4时CRP的表达较T0增高(P<0.05),介入组各时间点组内无显著变化(P>0.05)。开胸组NSE在T1~T4时较T0时显著升高(P<0.05),同时其表达也明显高于介入组(P<0.05)。S100β的表达在T1时达峰并逐渐降低,在T1~T3明显高于介入组,T4时其表达降至T0水平(P>0.05)。介入组NSE和S100β各时间点组内无显著变化(P>0.05)。另外,开胸组术后血浆NSE及S100β浓度的高低与ICU住院时间及总住院日间无明显相关性。结论先天性心脏病开胸手术诱发的炎症反应明显高于介入组,由此产生的脑损伤风险可能也较介入组更明显。

Objective To investigate and compare the expression changes of neuro-injury biomarkers NSE and S100βas well as inflammatory factors TNF-α,IL-6,and CRP in patients'serum between open-heart surgery and intervention therapy.Methods Thirty-six patients with congenital heart defect were elected and divided into two groups(open-heart surgery group,n=18,interven⁃tion therapy group,n=18).The concentration of NSE,S100β,TNF-α,IL-6,and CRP were measured at five time points:before the operation(T0),immediately after the operation(T1),6,12 and 24 hours after the operation(T2,T3 and T4)by the technique of enzyme linked immunosorbent assay(ELISA).Results The concentration of TNF-α,IL-6,and CRP were significantly higher in T1-T4 than T0 in open-heart group(P<0.05).Meanwhile,they were also significantly higher than intervention group in T1-T4(P<0.05).No statistically difference was observed during the operation in intervention group(P>0.05)except that the concentration of CRP was significantly higher in T4 than T0(P<0.05).The concentration of NSE in open-heart surgery group was obviously increased in T1 to T4(P<0.05),and they were also significantly higher than those in intervention group at the same time points(P<0.05).The peak of S100βwas observed in T1 and gradually decreased to T0 level at T4.No statistical significance was detected in both NSE and S100βin intervention group.Moreover,the concentration of NSE and S100βshowed no correlation with ICU stay as well as hospitalization time.Conclusion The inflammatory response induced by CPB in the open-heart surgery is more obvious than that of intervention therapy in congenital heart disease patients.And thus,the prevalence of brain injury might be higher in patients receiving open-heart surgery.