体外循环围手术期患者血浆中性粒细胞肽和弹性蛋白酶的动态观察  

The changes of HNP and NE content in serum during perioperation of cardiac surgery under cardiopulmonary bypass

作　　者：王永杰[1] 张育才[1] 巩新建[1] 王冬[1] 李玺[1] 

机构地区：[1]中国人民解放军第97医院检验科,江苏徐州221004

出　　处：《临床检验杂志》2006年第6期422-424,共3页Chinese Journal of Clinical Laboratory Science

基　　金：江苏省高校自然科学研究计划项目(03KJD310237)

摘　　要：目的了解体外循环(CPB)围手术期患者血浆中性粒细胞肽(HNP)和中性粒细胞弹性蛋白酶(NE)在CPB诱发的全身性炎症反应综合征(SIRS)早期诊断中的价值。方法以ELISA法定量测定CPB患者围手术期不同时间血浆中HNP1-3和NE的含量,同时测定血浆CK、CK-MB和CRP含量。结果21例心脏直视手术患者CPB前血浆HNP1-3和NE含量(x-±s)分别为(54.6±26.5)ng/ml和(41.1±9.9)ng/ml;CPB后0.5h分别为(435.5±500.1)ng/ml和(250.9±97.2)ng/ml,比CPB前显著升高(P<0.001);CPB后4h血浆HNP1-3和NE含量达峰值,此后开始下降;血浆HNP1-3和NE浓度变化呈显著正相关(r=0.874,P<0.001)。血浆CK、CK-MB和CRP峰值出现在CPB后24h,分别为(1587.5±1500.6)U/L,(38.2±39.3)U/L和(62.6±27.1)mg/L。结论血浆HNP1-3和NE对CPB诱发SIRS反应敏感、迅速,血浆浓度的动态变化可能提示SIRS的严重程度和发展趋势。Objective To observe the changes of HNP1-3 and NE content in serum quantitatively during perioperation of cardiac surgery under cardiopulmonary bypass（ CPB）, and to explore the role of changes of HNP1-3 and NE content in early diagnosis of system inflammatory response syndromes（SIRS） after cardiopulmonary bypass. Methods The contents of HNP1-3 and NE in serum during perioperation of 21 cardiac surgeries under cardiopulmonary bypass were measured quantitatively using ELISA method,and the contents of CK, CK-MB and C-RP in serum were measured at the same time points as that of HNP1-3 and NE. Results The contents of HNP1-3 and NE in serum were 54.55 ± 26.45 ng/ml and 41.09 ± 9.93 ng/ml respectively before CPB, and they were 435.45± 500. 13 ng/ml and 250.91 ±97.21 ng/ml respectively 0.5 h after CPB which were significantly higher than that before CPB（ P 〈 0. 001 ）. The contents of HNP1-3 and NE rise to peak value 4 hours after CPB, which were 454.18 ± 651.20 ng/ml and 243.64 ± 81.43 ng/ml respectively, and then the contents of HNP1-3 and NE decreased. The changes of contents of HNP1-3 and NE had positive correlation（ r = 0. 874, P 〈 0. 001 ）. The peak time of CK, CK-MB and C-RP in serum was 24 hours after CPB, and the peak value of them were 1587.46± 1500.56 U/L,38.18 ± 39.27 U/L and 62.63 ± 27.08 mg/L respectively. Conclusion The response of HNP1-3 and NE to the SIRS after CPB was sensitive and rapid, and the changes of content of HNP1-3 and NE in serum might be used to predict the serious degree and tendency of SIRS after CPB.

关 键 词：体外循环 中性粒细胞肽 弹性蛋白酶 

分 类 号：R645.2[医药卫生—外科学]