先天性心脏病体外循环术后细菌DNA移位的临床研究  

Clinical study of bacterial DNA translation after cardiopulmonary bypass in congenital heart dis⁃ease children

作　　者：陈峰 葛俊文 李佳[1] 陈小龙 龚瑾[1] 谢业伟 李小兵[1] 沈立[1] 张儒舫[1] Chen Feng;Ge Junwen;Li Jia;Chen Xiaolong;Gong Jin;Xie Yewei;Li Xiaobing;Shen Li;Zhang Rufang(Department of Cardiothoracic Surgery,Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China)

机构地区：[1]上海交通大学医学院附属儿童医院,上海市儿童医院心胸外科,上海200062

出　　处：《中华小儿外科杂志》2022年第11期1018-1022,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(81371449)。

摘　　要：目的探讨先天性心脏病患儿体外循环术后肠道屏障功能损伤、细菌DNA移位及其与术后发生全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)之间的关系。方法收集2018年7月至2019年7月上海交通大学医学院附属儿童医院心胸外科收治的61例先天性心脏病行体外循环手术患儿,其中男29例,女32例;年龄为(744.8±947.8)d,年龄范围为2 d~14岁。按术后是否发生SIRS分为SIRS组及无SIRS组。术前和术后2 h、24 h采集静脉血,利用PCR技术进行细菌DNA检测,同时检测肠道损伤标志物二胺氧化酶及肠型脂肪酸结合蛋白,并观察术后是否发生SIRS。结果①所有患儿术前细菌PCR均为阴性,术后2 h(322.4±279.6 copies/μl)、术后24 h(366.6±294.9 copies/μl)细菌DNA拷贝数明显较术前升高,与术前相比差异均有显著性(P<0.001);②体外循环术后2 h血清二胺氧化酶(148.5±93.2 mIU/ml)、肠型脂肪酸结合蛋白(7.8±7.2 ng/ml)水平较术前明显升高,24 h后开始下降,术后2 h、24 h与术前相比差异有显著性(P=0.012、P=0.0089);③SIRS组术后24 h二胺氧化酶、肠型脂肪酸结合蛋白水平明显升高,与非SIRS组相比差异有显著性(P=0.0308、P=0.0282)。结论体外循环术后早期即可发生肠道细菌DNA移位,先天性心脏病体外循环术后SIRS与肠道细菌DNA移位有相关性。Objective To explore the relationship among postoperative intestinal barrier damage,intestinal bacterial translocation and postoperative systemic inflammatory response syndrome(SIRS)in children with congenital heart disease(CHD)after cardiopulmonary bypass(CPB).Methods From July 2018 to July 2019,clinical data were reviewed for 61 CHD children undergoing cardiothoracic surgery.There were 29 boys and 32 girls with an age range of(744.8±947.8)days(2 days to 14 years).They were divided into two groups of SIRS and non⁃SIRS according to the presence or absence of postoperative SIRS.According to the results of polymerase chain reaction(PCR),two groups of PCR⁃positive and PCR⁃negative were assigned.Copy number of blood bacterial DNA was determined by PCR at pre⁃CPB and post⁃CPB 2/24h.At the same time,the serum levels of diamine oxidase(DAO)and intestinal fatty acid binding protein(IFABP)were detected by enzyme⁃linked immunosorbent assay(ELISA).Results Preoperative bacterial PCR was negative.Copy number of bacterial DNA was significantly higher at 2h(322.4±279.6 copies/μl)and 24h post⁃operation(366.6±294.9 copies/μl)than that of pre⁃operation(P<0.001).The serum levels of DAO(148.5±93.2 mIU/ml)and IFABP(7.8±7.2 ng/ml)spiked at 2h post⁃CPB(p=0.012,p=0.0089)and declined at 24 h post⁃CPB.Significant differences existed among pre⁃operation,2/24h post⁃CPB.The levels of DAO and IFABP increased significantly in SIRS group at 24h postoperatively and it was significantly different from that in non⁃SIRS group(P=0.0308,P=0.0282).Conclusion Intestinal bacterial DNA translocation occurs in early period post⁃CPB.SIRS is closely correlated with intestinal bacterial DNA translocation after CPB.

关 键 词：心肺转流术 先天性心脏病 细菌移位 聚合酶链式反应 脂肪酸结合蛋白 

分 类 号：R726.5[医药卫生—儿科]