围体外循环期中性粒细胞活化与心脏手术相关急性肾损伤  

Neutrophil activation is correlated with acute kidney injury after cardiac surgery under cardiopulmonary bypass

作　　者：王婷婷[1,2] 姚媛媛[2] 孙佳毅[3] 吴娟 廖心怡 孟文彤 严敏[2] 杜磊[1] 熊际月[1] WANG Tingting;YAO Yuanyuan;SUN Jiayi;WU Juan;LIAO Xinyi;MENG Wentong;YAN Min;DU Lei;XIONG Jiyue(Department of Anesthesiology,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Anesthesiology,Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Applied Biology and Biotechnology,The Hong Kong Polytechnic University,Hong Kong 999077,China;Laboratory of Stem Cell Biology,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院麻醉科,四川成都610041 [2]浙江大学医学院附属第二医院麻醉科,浙江杭州310000 [3]香港理工大学应用生物与生物技术系,中国香港九龙999077 [4]四川大学华西医院干细胞生物学实验室,四川成都610041

出　　处：《中国输血杂志》2025年第3期358-367,共10页Chinese Journal of Blood Transfusion

基　　金：国家科技重大专项(2023ZD0504400)。

摘　　要：目的 探讨围体外循环(CPB)期中性粒细胞活化与心血管手术相关急性肾损伤(CS-AKI)的关系。方法 纳入2022年5月1日-2023年3月31日在本院接受择期CPB下心脏手术的成年患者,主要预后指标为AKI。分别于术前、复温、CPB结束和术后24 h采集中心静脉血5 mL,使用CD11b、CD54等标记活化中性粒细胞。通过倾向性评分匹配(PSM)平衡AKI和非AKI间协变量,分析活化中性粒细胞变化规律与AKI的关系。结果 纳入研究的120例患者中,17例(14.2%)发生AKI。复温时CD11b^(+)、CD54^(+)中性粒细胞开始升高并持续至术后24 h。AKI组CD11b~+中性粒细胞在复温时高于非AKI(4.71×10^(9)/L vs 3.31×10^(9)/L,Z=-2.14,P<0.05),而CD54~+细胞则在术前(2.75×10^(9)/L vs 1.79×10^(9)/L,Z=-2.99,P<0.05)、复温(3.12×10^(9)/L vs 1.62×10^(9)/L,Z=-4.34,P<0.05)和CPB结束(4.28×10^(9)/L vs 2.14×10^(9)/L,Z=-3.91,P<0.05)时AKI均高于非AKI。对匹配获得的32例患者(每组16例)分析显示,AKI组CD11b~+、CD54~+中性粒细胞在复温时分别为非AKI组的1.74倍(4.83×10^(9)/L vs 2.77×10^(9)/L,Z=-2.72,P<0.05)和2.34倍(3.32×10^(9)/L vs 1.42×10^(9)/L,Z=-4.12,P<0.05)。结论 围CPB期大量中性粒细胞被活化,这些细胞可被CD11b/CD54标记。活化中性粒细胞在复温时组间差异最大,AKI约为非AKI的2倍。这些证据提示,在复温时去除50%的活化细胞可能会有效降低AKI风险。Objective To explore the relationship between neutrophil activation under cardiopulmonary bypass(CPB)and the incidence of cardiac surgery-associated acute kidney injury(CS-AKI).Methods This prospective cohort study en-rolled adult patients who scheduled for cardiac surgery under CPB at West China Hospital between May 1,2022 and March 31,2023.The primary outcome was acute kidney injury(AKI).Blood samples(5 mL)were obtained from the central vein before surgery,at rewarming,at the end of CPB,and 24 hours after surgery.Neutrophils were labeled with CD11b,CD54 and other markers.To assess the effect of neutrophils activation on AKI,propensity score matching(PSM)was employed to equilibrate covariates between the groups.Results A total of 120 patients included into the study,and 17(14.2%)de-veloped AKI.Both CD11b+and CD54+neutrophils significantly increased during the rewarming phase and the increases were kept until 24 hours after surgery.During rewarming,the numbers of CD11b+neutrophils were significantly higher in AKI compared to non-AKI(4.71×10^(9)/L vs 3.31×10^(9)/L,Z=-2.14,P<0.05).Similarly,the CD54+neutrophils counts were also significantly higher in AKI than in non-AKI before surgery(2.75×10^(9)/L vs 1.79×10^(9)/L,Z=-2.99,P<0.05),during rewarming(3.12×10^(9)/L vs 1.62×10^(9)/L,Z=-4.34,P<0.05),and at the end of CPB(4.28×10^(9)/L vs 2.14×10^(9)/L,Z=-3.91,P<0.05).An analysis of 32 matched patients(16 in each group)revealed that CD11b+and CD54+neutrophil levels of AKI were 1.74 folds(4.83×10^(9)/L vs 2.77×10^(9)/L,Z=-2.72,P<0.05)and 2.34 folds(3.32×10^(9)/L vs 1.42×10^(9)/L,Z=-4.12,P<0.05),respectively,of non-AKI at rewarming phase.Conclusion Neutrophils are acti-vated during CPB,and they can be identified by CD11b/CD54 markers.The activated neutrophils of AKI patients are ap-proximately 2 folds of non-AKI during the rewarming phase,with disparity reached peak between groups during rewarming.These findings suggest the removal of 50% of activated neutrophils during the rewarming phase may be effective to r

关 键 词：心血管手术 体外循环 急性肾损伤 中性粒细胞 活化 

分 类 号：R457.1[医药卫生—治疗学] R331.142[医药卫生—临床医学] R541