血浆S100A12与婴幼儿体外循环术后非感染性肺部并发症的相关性研究  

Studying the association of plasma S100A12 and noninfectioiis pulmonary complication in infants and young children following cardiopulmonary bypass

作　　者：刘喜旺[1] 舒强[1] 陈迟[1] 施珊珊[1] 石卓[1] 俞建根[1] 林茹[1] 谈林华[1] 陈齐兴[2] 

机构地区：[1]浙江大学医学院附属儿童医院心胸外科、生殖遗传教育部重点实验室,杭州310003 [2]浙江大学医学院附属第一医院

出　　处：《中华急诊医学杂志》2012年第10期1134-1139,共6页Chinese Journal of Emergency Medicine

基　　金：国家科技支撑计划专项资金（2012BAl04805）;浙江省科技厅项目（2011C23011）;浙江省医药卫生科技计划项目（2012ZDA031）

摘　　要：目的动态观察婴幼儿体外循环（CPB）围术期血浆中S100A12和可溶性晚期糖基化终末产物受体（sRAGE）水平变化，探讨其在婴幼儿CPB术后非感染性肺部并发症（NPC）早期预测中的作用。方法采用病例对照研究。选取2011年6月1日至7月31日，在浙江大学附属儿童医院行CPB下心内直视矫治术、年龄〈3岁的先天性心脏病患儿。排除术前肺部有炎症性疾病和肝肾功能异常的患儿。根据术后是否出现胸腔积液、乳糜胸、部分肺不张、肺动脉高压危象、气道紊乱、气胸、纵膈积气、膈神经麻痹，20例被分为NPC组，40例被分为no-NPC组。于手术前，CPB前，CPB后，手术后1、12和24h,采用ELISA法检测血浆中S100A12和sRAGE浓度。两组之间的浓度差异采用t检验；多因素Logistic回归分析检验S100A12和sRAGE在术后NPC早期预测中的作用，并以优势比（OR）及95%可信区间（95%CI）表示相对危险度；以P〈0.05为差异具有统计学意义。结果血桨中S100A1212和sEAGE浓度在CPB后立刻明显升高（P〈0.01）。术后24h后血浆中sRAGE水平明显低于术前水（P〉〈0.05），而S100A12仍明显高于术前水平（P〈0.01）。CPB术后即刻，MPC组血浆中S100A12和sRAGE水平明显高于no-NPC组（P〈0.05）。术后24hNPC组血浆中S100A12水平仍明显高于no-NPC组（P〈0.05），而两组患儿血浆中sRAGE水平无明显差异（P〉0.05）。逐步法Logistic回归分析，CPB后即刻血浆中S100A12水平与术后NPC的发生明显相关（0R=1.042,95%Cl：1.010-1.076，P=0.011）。CPB后即刻血浆中S100A12与术后机械通气时间（r=0.47,P〈0.01）、住ICU时间（r=0.363，P=0.008）和住院时间（r=0.402，P=0.002）明显相关。结论婴幼儿CPB术后血浆中S100A12和sRAGE水平立刻明显升高。血浆中S100A12是婴幼儿CPB术后NPC发生和预后的早期预测指标。Objective To examine the kinetics of plasma S100A12 and soluble receptor for advanced glycation end products （ sRAGE） in infants and young children undergoing cardiopulmonary bypass （ CPB）, and to investigate whether they could protective the occurrence of noninfectious pulmonary complication （NPC） after cardiac surgery. Methods This was a case-control study. The subjects included all children aged 〈3 years old who underwent cardiac surgery with CPB during the period from June 1st to July 31st was excluded. The remain patients were divided into 2 groups according to whether they had developed NPC post operatively. Twenty patients were grouped into NPC because they developed the complications of pleural effusion,chylothorax,partial lung collapse,pulmonary hypertensive crisis,airway disorders,pneumothorax, pneumomediastinum, or phrenic nerve palsy. Forty patients were categorized into the no-NPC group. Plasma concentrations of S100A12 and sRAGE were measured using ELISA at baseline, before CPB, immediately after CPB, 1 h, 12 h and 24 h after operation. Differences concentrations between two groups were analyzed with t test. A stepwise logistic regression analysis was used to indentify the independent risk factor for NPC. A P value 〈0.05 was considered statistically significant. Results Plasma levels of S100A12 and sRAGE dramatically increased immediately after CPB （ P 〈 0. 01 ）. The levels of sRAGE dropped to lower than baseline level （P 〈 0. 05 ）,while S100A12 was still at high level 24h after operation （〈0. 01 ） . Levels of S100A12 and sRAGE immediately after CPB in NPC group were significantly higher than the no-NPC group （P 〈 0. 05 ） . Twenty-four hours after operation, levels of S100A12 were still higher in NPC group than no-NPC （P 〈 0. 01 ） , while levels of sRAGE were similar in the two groups （P 〉 0. 05 ） . In the stepwise logistic regression analysis,plasma S100A12 level immediately after CPB remained as a independently predictor for postoperative NPC �

关 键 词：S100A12 可溶性晚期糖基化终末产物(sRAGE) 非感染性肺部并发症 体外循 环 心脏手术 先天性心脏病 婴幼儿 病历对照 相关性. 

分 类 号：R726.5[医药卫生—儿科]