循环细胞外囊泡粒径特征与体外循环心脏手术后凝血功能的关系  

The relationship between size distribution of circulating extracellular vesicles and coagulation function after cardiac surgery

作　　者：曹洪宇 袁浩翔 陈超 简宇鹏 李钰泉 刘晓军 马振升 李艳[1] 区景松[1] Cao Hongyu;Yuan Haoxiang;Chen Chao;Jian Yupeng;Li Yuquan;Liu Xiaojun;Ma Zhensheng;Li Yan;Ou Jingsong(Department of Cardiac Surgery,Cardiovascular Diseases Institute,the First Affiliated Hospital,Sun Yat-sen University,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases,NHC Key Laboratory of Assisted Circulation and Vascular Diseases(Sun Yat-sen University),Key Laboratory of Assisted Circulation and Vascular Diseases,Chinese Academy of Medical Sciences,Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases,Guangdong Provincial Key Laboratory of Brain Function and Disease,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院心脏外科,血管疾病诊治技术国家地方联合工程实验室(广东),国家卫健委辅助循环重点实验室(中山大学),中国医学科学院辅助循环及血管相关疾病重点实验室,广东省血管疾病诊治工程技术研究中心,广东省脑功能与脑疾病重点实验室,广州510080

出　　处：《中华胸心血管外科杂志》2025年第3期183-190,共8页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划项目(2021YFA0805100);国家自然科学基金重大项目课题和重大研究计划重点项目(82495171、92268202);中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2023-PT320-03);广东省自然科学基金青年提升项目(2024A1515030041);中山大学临床医学研究5010计划项目(2014002)。

摘　　要：目的探讨体外循环(CPB)心脏手术前后循环细胞外囊泡(EVs)粒径的变化与术后凝血功能之间的关系。方法共纳入103例接受CPB心内直视手术的患者,分别在术前、术后12 h和术后3天采集静脉血标本。同时,选取50例年龄、性别匹配的健康志愿者作为对照组。采用梯度离心法分离EVs,并利用动态光散射(DLS)方法检测EVs的粒径分布。通过分析EVs的粒径特征(包括峰直径、峰高和四分位数间距IQR),探讨其与CPB术后凝血功能的相关性。结果与术后凝血功能正常的患者相比,术后出现凝血功能障碍的患者EVs的峰直径和IQR较低,峰高显著升高。Logistic回归分析表明,术后EVs升高的峰高以及较低的峰直径和IQR是发生凝血功能障碍的危险因素。术后12 h EVs峰高诊断凝血功能障碍的曲线下面积(AUC)0.76,在最佳截值8.2时的阳性预测值85%;术后12 h IQR的AUC 0.84,在最佳截值125.05 nm时的敏感度83%,特异性82%,阴性预测值86%。结论循环EVs的粒径特征与CPB心脏手术后凝血功能有一定的相关性,可作为辅助预测手术后凝血功能障碍的新标志物。ObjectiveTo investigate the relationship between the changes in extracellular vesicles(EVs)size distribution before and after cardiopulmonary bypass(CPB)cardiac surgery and postoperative coagulation function.MethodsA total of 103 patients undergoing cardiac surgery with CPB were enrolled.Venous blood samples were collected at preoperation,postoperative 12 h and 3 days.Additionally,50 age-and gender-matched healthy volunteers served as a control group.EVs were isolated using gradient centrifugation,and their size distribution was assessed by dynamic light scattering(DLS).The relationship between EV size characteristics,including peak diameter,peak height,and interquartile range(IQR),and postoperative coagulation function was analyzed.ResultsCompared to patients with normal postoperative coagulation function,those with postoperative coagulation dysfunction had lower size at peak and IQR,and significantly higher peak intensity.Logistic regression analysis indicated that elevated peak intensity and lower size at peak and IQR were risk factors for coagulation dysfunction.The area under the curve(AUC)for diagnosing coagulation dysfunction with 12 h postoperative EVs peak intensity was 0.76,with a positive predictive value of 85%at the optimal cutoff of 8.2;the AUC for IQR was 0.84,with a sensitivity of 83%,specificity of 82%,and negative predictive value of 86%at the optimal cutoff of 125.05 nm.ConclusionThe size distribution of circulating EVs show a correlation with coagulation function after cardiac surgery with CPB and may serve as a novel biomarker to predict postoperative coagulation dysfunction.

关 键 词：细胞外囊泡 心脏手术 凝血功能 体外循环 

分 类 号：R654.2[医药卫生—外科学]