婴幼儿围心脏手术期铁调素变化及其意义
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摘要
目的观察婴幼儿围心脏手术期循环中铁调素水平动态变化情况,初步探索其与临床预后的相关性。方法选取2017年1月在心肺转流(CPB)下行心脏手术、年龄<3岁的先天性心脏病患儿18例。于手术前,CPB前,CPB后1 h、6 h、12 h和24 h,采用ELISA法检测血浆中铁调素的质量浓度。在手术后第一天和第二天分别检测患儿肝肾功能并记录血肌酐值。记录患儿一般临床资料、住心脏重症监护室(CICU)时间和手术后住院时间。对血浆铁调素水平与临床相关参数的关系进行分析。以P <0.05为差异具有统计学意义。结果血浆中铁调素水平在CPB后1 h即较手术前明显升高(P <0.001),且在CPB后24 h仍明显高于术前水平(P <0.001)。CPB术后1 h血浆中铁调素的质量浓度与患儿术后肾功能障碍明显正相关,表现为与手术后血肌酐水平正相关(r=0.76,P <0.001);还与患儿住CICU时间(r=0.69,P=0.001)和手术后住院时间(r=0.7,P=0.001)正相关。结论婴幼儿CPB术后循环中升高的铁调素与术后血肌酐水平、住院时间有关,可能作为影响婴幼儿CPB下心脏手术预后的早期预警指标。
Objective To examine the kinetics of plasma hepcidin in infants and young children undergoing cardiopulmonary bypass( CPB),and to investigate the association between hepcidin level and clinical outcomes after cardiac surgery. Methods The subjects included all children aged <3 years old who underwent cardiac surgery with CPB from January 1 stto 31 stin 2017. Plasma concentrations of hepcidin were measured by ELISA at baseline,before CPB,1 h,6 h,12 h and 24 h after CPB respectively. Serum creatinine levels were measured at first 2 days after the operations. The patients' demographic and clinical characteristics were also recorded. The relationship between plasma hepcidin level and clinical parameters was analyzed. A P value <0.05 was considered statistically significant. Results Plasma hepcidin level significantly increased 1 hour after CPB( P <0.001),and remained high 24 h after CPB( P <0.001). The plasma hepcidin level 1 hour after CPB was correlated with serum creatinine level( r= 0.76,P <0.001) and it was correlated with longer cardiac intensive care unit stay( r = 0.69,P = 0.001) and total hospital stay( r = 0.66,P = 0.003). Conclusion Increase of plasma hepcidin in children is positively related to serum creatinine level after CPB and the length of hospital stay. It may serve as an early quantifiable alarming biomarker for the prognosis of cardiac surgery under CPB in infants and young children.
Objective To examine the kinetics of plasma hepcidin in infants and young children undergoing cardiopulmonary bypass( CPB),and to investigate the association between hepcidin level and clinical outcomes after cardiac surgery. Methods The subjects included all children aged <3 years old who underwent cardiac surgery with CPB from January 1 stto 31 stin 2017. Plasma concentrations of hepcidin were measured by ELISA at baseline,before CPB,1 h,6 h,12 h and 24 h after CPB respectively. Serum creatinine levels were measured at first 2 days after the operations. The patients' demographic and clinical characteristics were also recorded. The relationship between plasma hepcidin level and clinical parameters was analyzed. A P value <0.05 was considered statistically significant. Results Plasma hepcidin level significantly increased 1 hour after CPB( P <0.001),and remained high 24 h after CPB( P <0.001). The plasma hepcidin level 1 hour after CPB was correlated with serum creatinine level( r= 0.76,P <0.001) and it was correlated with longer cardiac intensive care unit stay( r = 0.69,P = 0.001) and total hospital stay( r = 0.66,P = 0.003). Conclusion Increase of plasma hepcidin in children is positively related to serum creatinine level after CPB and the length of hospital stay. It may serve as an early quantifiable alarming biomarker for the prognosis of cardiac surgery under CPB in infants and young children.
引文
[1]赵聪聪,刘晋萍,冯正义,等.应用心脑联合灌注策略改善复杂主动脉畸形患儿术后早期预后的临床研究[J].中国体外循环杂志,2017,15(1):13-17.
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[15] Martines AM,Masereeuw R,et al. Iron metabolism in the pathogenesis of iron-induced kidney injury[J]. Nat Rev Nephrol,2013,9(7):385-398.
[16] Ho J,Tangri N,Komenda P,et al. Urinary,plasma,and serum biomarkers'utility for predicting acute kidney injury associated with cardiac surgery in adults:a meta-analysis[J]. Am J Kidney Dis,2015,66(6):993-1005.
[17] Sdogou T,Tsentidis C,Gourgiotis D,et al. Immunoassay-based serum hepcidin reference range measurements in healthy children:differences among age groups[J]. J Clin Lab Anal,2015,29(1):10-14.
[18] Choi HS,Song SH,Lee JH,et al. Serum hepcidin levels and iron parameters in children with iron deficiency[J]. Korean J Hematol,2012,47(4):286-292.
[19] Huang YH,Yang KD,Hsu YW,et al. Correlation of HAMP gene polymorphisms and expression with the susceptibility and length of hospital stays in taiwanese children with kawasaki disease[J]. Oncotarget,2017,8(31):51859-51868.
[2] Burte F,Brown BJ,Orimadegun AE,et al. Circulatory hepcidin is associated with the anti-inflammatory response but not with iron or anemic status in childhood malaria[J]. Blood,2013,121(15):3016-3022.
[3] De Domenico I,Zhang TY,Koening CL,et al. Hepcidin mediates transcriptional changes that modulate acute cytokine-induced inflammatory responses in mice[J]. J Clin Invest,2010,120(7):2395-2405.
[4] Wang CY,Babitt JL. Hepcidin regulation in the anemia of inflammation[J].Curr Opin Hematol,2016,23(3):189-197.
[5] Choi N,Whitlock R,Klassen J,et al. Early intraoperative ironbinding proteins are associated with acute kidney injury after cardiac surgery[J].J Thorac Cardiovasc Surg,2019,157(1):287-297.
[6] Hung M,Ortmann E,Besser M,et al. A prospective observational cohort study to identify the causes of anaemia and association with outcome in cardiac surgical patients[J]. Heart,2015,101(2):107-112.
[7] Haase-Fielitz A,PlaM,Kuppe H,et al. Low preoperative hepcidin concentration as a risk factor for mortality after cardiac surgery:a pilot study[J]. J Thorac Cardiovasc Surg,2013,145(5):1380-1386.
[8] Zaritsky J,Young B,Gales B,et al. Reduction of serum hepcidin by hemodialysis in pediatric and adult patients[J].Clin J Am Soc Nephrol,2010,5(6):1010-1014.
[9] Reichert CO,da Cunha J,Levy D,et al. Hepcidin:homeostasis and diseases related to iron metabolism[J]. Acta Haematol,2017,137(4):220-236.
[10] Yuan SM. Acute kidney injury after pediatric cardiac surgery[J].Pediatr Neonatol,2019,60(1):3-11.
[11] Shi SS,Yue XJ,Zhao DY,et al. Plasma gelsolin level predicts acute kidney injury after cardiopulmonary bypass in infants and young children[J].World J Pediatr,2018,14(2):143-150.
[12] Ho J,Reslerova M,Gali B,et al. Urinary hepcidin-25 and risk of acute kidney injury following cardiopulmonary bypass[J]. Clin J Am Soc Nephrol,2011,6(10):2340-2346.
[13] Haase-Fielitz A,Mertens PR,Plass M,et al. Urine hepcidin has additive value in ruling out cardiopulmonary bypass-associated acute kidney injury:an observational cohort study[J]. Crit Care,2011,15(4):R186.
[14] Wang Y,Bellomo R. Cardiac surgery-associated acute kidney injury:risk factors,pathophysiology and treatment[J]. Nat Rev Nephrol,2017,13(11):697-711.
[15] Martines AM,Masereeuw R,et al. Iron metabolism in the pathogenesis of iron-induced kidney injury[J]. Nat Rev Nephrol,2013,9(7):385-398.
[16] Ho J,Tangri N,Komenda P,et al. Urinary,plasma,and serum biomarkers'utility for predicting acute kidney injury associated with cardiac surgery in adults:a meta-analysis[J]. Am J Kidney Dis,2015,66(6):993-1005.
[17] Sdogou T,Tsentidis C,Gourgiotis D,et al. Immunoassay-based serum hepcidin reference range measurements in healthy children:differences among age groups[J]. J Clin Lab Anal,2015,29(1):10-14.
[18] Choi HS,Song SH,Lee JH,et al. Serum hepcidin levels and iron parameters in children with iron deficiency[J]. Korean J Hematol,2012,47(4):286-292.
[19] Huang YH,Yang KD,Hsu YW,et al. Correlation of HAMP gene polymorphisms and expression with the susceptibility and length of hospital stays in taiwanese children with kawasaki disease[J]. Oncotarget,2017,8(31):51859-51868.