国际麻醉学与复苏杂志   2020, Issue (2): 4-4
    
促血管生成素/Tie2在体外循环心脏手术患者围手术期表达的动态观察
徐继红, 朱佳丽, 陈霞, 李金宝1()
1.上海交通大学附属第一人民医院
Dynamic observation of the expression of angiopoietin/Tie2 in the perioperative period of patients undergoing cardiac surgery with cardiopulmonary bypass
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摘要:

目的 观察CPB心脏手术患者围手术期外周血中促血管生成素(angiopoietin, Ang)、Tie2水平及其与患者预后的相关性。 方法 2017年1月至2017年12月择期行CPB下心脏手术患者31例。分别于术前(T1)、术后6 h(T2)、术后第1天(T3)、术后第3 天(T4)及术后第5 天(T5)采集患者外周血,检测并比较血浆中乳酸(lactic acid, Lac)水平和血细胞数,采用ELISA法检测血浆中Ang‑1、Ang‑2、可溶性Tie2(sTie2)水平并进行比较。分析Ang、Tie2水平与CPB心脏手术患者术中CPB时间、术后ICU停留时间的相关性。 结果 与T1比较,T2~T5时WBC及中性粒细胞数量均明显增多,T2时Lac水平明显升高,T3、T4时Ang‑1浓度明显降低,Ang‑2浓度明显升高,T2~T4时Ang‑1/Ang‑2及sTie2水平明显降低(P<0.05)。与T2比较,T3~T5时Lac水平明显下降,T3、T4时Ang‑1浓度及Ang‑1/Ang‑2明显降低,Ang‑2浓度明显升高,T4、T5时sTie2明显升高(P<0.05)。与T3比较,T4时Ang‑1/Ang‑2明显降低,T5时Ang‑1/Ang‑2及sTie2明显升高(P<0.05)。与T4比较,T5时Ang‑1浓度及Ang‑1/Ang‑2明显升高(P<0.05)。T3时患者血浆中Ang‑1/Ang‑2与手术CPB时间、ICU停留时间存在负性相关,相关系数分别为−0.64和−0.59(P<0.01);血浆sTie2的浓度与手术CPB时间、ICU停留时间呈负性相关,相关系数为−0.93和−0.69(P<0.01)。 结论 CPB心脏手术患者围手术期血浆中Ang、Tie2水平发生动态改变,有利于改善心脏手术患者术后管理,从而减少ICU停留时间。

关键词: 心脏手术; 体外循环; 促血管生成素; Tie2; 内皮细胞; 炎症反
Abstract:

Objective To observe the levels of angiopoietin (Ang) and Tie2 in the peripheral blood of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and analyze their relationship with patient prognosis. Methods Thirty one patients scheduled for cardiac surgery with CPB from January 2017 to December 2017 were enrolled. Their peripheral blood samples were collected before surgery (T1), 6 h after surgery (T2), Day 1 after surgery (T3), Day 3 after surgery (T4), and Day 5 after surgery (T5) to measure and compare the level of lactic acid (Lac) and blood cell counts. The enzyme‑linked immunosorbent assay (ELISA) was adopted to determine and compare the levels of plasma Ang‑1, Ang‑2 and soluble Tie2 (sTie2). The relationship between the levels of Ang and Tie2, and the duration of CPB and the length of postoperative stay in the intensive care unit (ICU) for the patients were analyzed. Results Compared with those at T1, the number of white blood cells (WBCs) and neutrophils remarkably increased from T2 to T5, the level of Lac obviously increased at T2, at T3 and T4, the concentration of Ang‑1 obviously decreased, and the concentration of Ang‑2 obviously increased, and the ratio of Ang‑1/Ang‑2 and sTie2 level remarkably declined from T2 to T4 (P<0.05). Compared with those at T2, the level of Lac obviously decreased from T3 to T5, at T3 and T4, the concentration of Ang‑1 and the ratio of Ang‑1/Ang‑2 remarkably declined, and the concentration of Ang‑2 obviously increased, and the level of sTie2 remarkably increased at T4 and T5 (P<0.05). Compared with those at T3, the ratio of Ang‑1/Ang‑2 obviously decreased at T4, while the ratio of Ang‑1/Ang‑2 and sTie2 level remarkably increased at T5 (P<0.05). Compared with those at T4, the concentration of Ang‑1 and the ratio of Ang‑1/Ang‑2 remarkably increased at T5 (P<0.05). At T3, the ratio of Ang‑1/Ang‑2 was negatively related with the duration of CPB and the length of ICU stay, with a correlation coefficient of −0.64 and −0.59, respectively (P<0.01), the level of sTie2 was negatively related with the duration of CPB and the length of ICU stay, with a correlation coefficient of −0.93 and −0.69, respectively (P<0.01). Conclusions The levels of plasma Ang and Tie2 dynamically change in the perioperative period of patients undergoing cardiac surgery with CPB, which facilitates patient management after surgery, so as to shorten the length of ICU stay.

Key words: Cardiac surgery; Cardiopulmonary bypass; Angiopoietin; Tie2; Endothelial cells; Inflammatory reaction