体外循环冠脉旁路术和双瓣替换术围术期血浆循环DNA变化及意义  

Perioperative changes of plasma circulating cell-free DNA in patients with coronary artery bypass graft and double valve replacement under cardiopulmonary bypass

作　　者：黄晶[1] 肖颖彬[1] 

机构地区：[1]第三军医大学新桥医院全军心血管外科中心,重庆400037

出　　处：《第三军医大学学报》2013年第12期1284-1287,共4页Journal of Third Military Medical University

基　　金：军队重大临床高新技术(2010GXJS069)~~

摘　　要：目的研究体外循环(cardiopulmonary bypass,CPB)下心内直视手术患者围术期血浆循环DNA(circulatingcell-free DNA,cf-DNA)浓度变化及手术前后肝、肾功能和心肌功能的变化及其临床意义。方法收集2012年9月至12月在本院心血管外科CPB下行心内直视手术的住院患者25例(男性13例,女性12例),冠状动脉粥样硬化性心脏病患者13例[行冠状动脉搭桥手术(coronary artery bypass graft,CABG),即CABG组];风湿性二尖瓣及主动脉瓣狭窄关闭不全患者12例[行二尖瓣及主动脉瓣双置换术(double valve replacement,DVR),即DVR组]。采集患者静脉血为标本,对肝肾功及心肌酶谱进行检测,并采用荧光定量PCR对血浆中cf-DNA进行相对定量检测。结果 CABG组和DVR组在术中cfDNA含量都随转流时间延长而增高,转流完毕时达到最高,术后48 h内逐步下降,但仍高于转流前。CABG组术后血浆cfDNA随时间下降比DVR组显著(P<0.05)。CABG组和DVR组术后24 h血浆cf-DNA变化与患者总胆红素及尿素氮的变化显著相关(P<0.01)。结论血浆cf-DNA在监测体外循环下患者机体受损程度以及预测肝肾并发症及预后方面可能具有重要意义。Objective To examine the changes of the concentration of plasma circulating cell-free DNA （cf-DNA） during cardiopulmonary bypass （CPB） open-heart surgery, and the changes of hepatic func- tion, renal function and myocardial enzymes before and after operation, and to explore the significance. Meth- ods Twenty-five patients admitted in our hospital from September 2012 to December 2012 were enrolled. Thirteen patients with coronary artery disease underwent coronary artery bypass graft （CABG） were enrolled as a CABG group and 12 patients with rheumatic heart disease underwent double valve replacement （DVR） were enrolled as a DVR group. Venous blood was collected for the determination of hepatic function, renal function and myocardial enzymes, and plasma cf-DNA was detected by fluorescent semi-quantitative PCR. Results The concentration of plasma cf-DNA was elevated significantly during CPB in both groups, it peaked at the end of CPB, and decreased along with time extending. However, the concentration of plasma cf-DNA at 48 h after operation was still higher than that before CPB. The decrease of plasma cf-DNA in the CABG group was signifi- cantly faster than that in the DVR group （P 〈 0.05 ）. The changes of plasma cf-DNA before and after operation were significantly correlated with total bilirubin and urea nitrogen （ P 〈 0. 01 ）. Conclusion Plasma cf-DNA can monitor the injury of patients during CPB, and may be a valuable marker for the diagnosis and prediction of CPB complications.

关 键 词：体外循环 血浆cf-DNA 围术期 

分 类 号：R446.9[医药卫生—诊断学] R619[医药卫生—临床医学]