影响腹膜后肿瘤切除患者多糖包被脱落的相关因素分析
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摘要
目的观察腹膜后肿瘤切除患者围术期血清炎症因子的变化及血管内皮多糖包被脱落的情况,分析影响多糖包被脱落的独立危险因素。方法选择择期行腹膜后肿瘤切除术的患者80例,分别检测患者术前(T0)、手术开始1h(T1)、手术开始4h(T2)、手术结束24h(T3)以及手术结束72h(T4)血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、蛋白聚糖-1(SDC-1)、透明质酸(HA)及硫酸乙酰肝素(HS)的水平,比较各时间点每个指标的变化趋势,并对影响多糖包被脱落的相关因素进行回归分析。结果与T0相比,T1、T2、T3和T4时间点患者血清IL-6、TNF-α、SDC-1、HA及HS的水平均有不同程度升高,其中T2、T3升高显著(P<0.01)。△SDC-1与△IL-6、△TNF-α及输液量呈正相关;△HA、△HS均只与△TNF-α及输液量呈正相关。围术期TNF-α的变化对术后多糖包被脱落的影响更大。结论腹膜后肿瘤切除患者围术期血清IL-6、TNF-α、SDC-1、HA及HS的水平明显升高,TNF-α的变化和输液量是围术期多糖包被脱落的独立危险因素。
Objective To observe the changes of serum inflammatory cytokines and vascular endothelial glycocalyx shedding during perioperative period in the patients undergoing retroperitoneal tumor resection,and to analyze the independent risk factors affecting glycocalyx shedding.Methods Eighty patients with elective retroperitoneal resection were enrolled in this study.The serum concentrations of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),syndecan-1(SDC-1),hyaluronic acid(HA)and heparan sulfate(HS)before surgery(T0),at 1 hafter the surgery begin(T1),4 hafter the surgery begin(T2),24 hafter surgery end(T3)and72 hafter surgery end(T4)were detected respectively.The change trend at each time point was compared among various indexes.The regression analysis was performed on the related factors affecting glycocalyx shedding.Results Compared with T0,the concentrations of serum IL-6,TNF-α,SDC-1,HA and HS at T1,T2,T3 and T4 were increased to different extents,in which the T2 and T3 increase was significant(P<0.01).△SDC-1 was positively correlated with△IL-6,△TNF-αand infusion volume;△HA and△HS were only positively correlated with△TNF-αand infusion volume.The perioperative TNF-αchanges had greater impact on postoperative glycocalyx shedding.Conclusion The concentrations of serum IL-6,TNF-α,SDC-1,HA and HS during perioperative period are significantly increased,and the TNF-αchange and infusion volume are the independent risk factors of perioperative glycocalyx shedding.
Objective To observe the changes of serum inflammatory cytokines and vascular endothelial glycocalyx shedding during perioperative period in the patients undergoing retroperitoneal tumor resection,and to analyze the independent risk factors affecting glycocalyx shedding.Methods Eighty patients with elective retroperitoneal resection were enrolled in this study.The serum concentrations of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),syndecan-1(SDC-1),hyaluronic acid(HA)and heparan sulfate(HS)before surgery(T0),at 1 hafter the surgery begin(T1),4 hafter the surgery begin(T2),24 hafter surgery end(T3)and72 hafter surgery end(T4)were detected respectively.The change trend at each time point was compared among various indexes.The regression analysis was performed on the related factors affecting glycocalyx shedding.Results Compared with T0,the concentrations of serum IL-6,TNF-α,SDC-1,HA and HS at T1,T2,T3 and T4 were increased to different extents,in which the T2 and T3 increase was significant(P<0.01).△SDC-1 was positively correlated with△IL-6,△TNF-αand infusion volume;△HA and△HS were only positively correlated with△TNF-αand infusion volume.The perioperative TNF-αchanges had greater impact on postoperative glycocalyx shedding.Conclusion The concentrations of serum IL-6,TNF-α,SDC-1,HA and HS during perioperative period are significantly increased,and the TNF-αchange and infusion volume are the independent risk factors of perioperative glycocalyx shedding.
引文
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[20]CHAPPELL D,HOFMANN-KIEFER K,JACOB M,et al.TNF-alpha induced shedding of the endothelial glycocalyx is prevented by hydrocortisone and antithrombin[J].Basic Res Cardiol,2009,104(1):78-89.
[21]GRUNDMANN S,FINK K,RABADZHIEVA L,et al.Perturbation of the endothelial glycocalyx in post cardiac arrest syndrome[J].Resuscitation,2012(83):715-720.
[22]BRUEGGER D,JACOB M,REHM M,et al.Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts[J].Heart Circul Physiol,2005,289(5):1993-1999.
[23]REHM M,HALLER M,ORTH V,et al.Changes in blood volume and hematocrit during acute preoperative volume loading with 5%albumin or 6%hetastarch solutions in patients before radical hysterectomy[J].Anesthesiology,2001(95):849-856.
[24]CHAPPELL D,JACOB M,HOFMANN-KIEFER K,et al.A rational approach to perioperative fluid management[J].Anesthesiology,2008,109(4):723-740.
[25]高志峰,冯艺,谷洁,等.目标导向液体治疗在腹膜后肿瘤切除术中的应用[J].中国医药,2017,12(10):1560-1564.
[26]CHAPPELL D,JACOB M,HOFMANN-KIEFER K,et al.Antithrombin reduces shedding of the endothelial glycocalyx following ischaemia/reperfusion[J].Card Res,2009,83(2):388-396.
[2] DOHERTY M,BUGGY D J.Intraoperative fluids:how much is too much?[J].Br J Anaesth,2012,109(1):69-79.
[3] USHIYAMA A,KATAOKAC H,IIJIMA T.Glycocalyx and its involvement in clinical pathophysiologies[J].J Intensive Care,2016,4(1):59.
[4] KOISEN-PETERSEN J A.The endothelial glycocalyx:the great luminal barrier[J].Acta Anaesth Scand,2015,59(2):137-139.
[5] TEPPAN J,HOFER S,FUNKE B,et al.Sepsis and major abdominal surgery lead to flaking of the endothelial glycocalix[J].J Surg Res,2011,165(1):136-141.
[6] BERNHARD B F,JACOB M,LEIPERT S,et al.Degradation of the endothelial glycocalyx in clinical settings:searching for the sheddases[J].British J Clin Pharmacol,2015,80(3):389-402.
[7] BECKER B F,CHAPPELL D,BRUEGGER D,et al.Therapeutic strategies targeting the endothelial glycocalyx:acute deficits,but great potential[J].Card Res,2010(87):300-310.
[8] SILLESEN M,RASMUSSEN L S,JIN G.Assessment of coagulopathy,endothelial injury,and inflammation aftertraumatic brain injury and hemorrhage in a porcine model[J].J Trauma Acute Care Surg,2014,76(1):12-19.
[9] STRUNDEN M S,BORNSCHEUER A,SCHUSTER A,et al.Glycocalyx degradation causes microvascular perfusion failure in the ex vivo perfused mouse lung:hydroxyethyl starch 130/0.4pretreatment attenuates this response[J].Shock,2012,38(5):559-566.
[10]NELSON A,BERKESTEDT I,SCHMIDTCHEN A,et al.Increased levels of glycosaminoglycans during septic shock:relation to mortality and the antibacterial actions of plasma[J].Shock,2008,30(6):623-627.
[11]SALLISALMI M,TENHUNEN J,YANG R,et al.Vascular adhesion protein-1and syndecan-1in septic shock[J].Acta Anaesth Scandia,2012,56(3):316-322.
[12]李敏,郝东,王涛,等.多糖包被在感染性休克中的变化及临床意义[J].中华危重病急救医学,2016,28(8):699-703.
[13]VOYVODIC P L,MIN D,LIU R,et al.Loss ofsyndecan-1induces a pro-inflammatory phenotype in endothelial cells with a dysregulated response to atheroprotective flow[J].J Biol Chem,2014,289(14):9547-9549.
[14]RAMNATH R,FOSTER R R,QIU Y,et al.Matrix metalloproteinase 9-mediated shedding of syndecan 4in response to tumor necrosis factorα:a contributor to endothelial cell glycocalyx dysfunction[J].FASEB J,2014,28(11):4686-4699.
[15]CHAPPELL D,HOFMANN-KIEFER K,JACOB M,et al.TNF-alpha induced shedding of the endothelial glycocalyx is prevented by hydrocortisone and antithrombin[J].Basic Res Cardiol,2009,104(1):78-89.
[16]NIEUWDORP M,MEUWESE M C,MOOIJ H L.Tumor necrosis factor-alpha inhibition protects against endotoxin-induced endothelial glycocalyx perturbation[J].Atherosclerosis,2009,202(1):296-303.
[17]谢青贞,杨菁,徐望明.重度妊娠高血压综合征患者血清诱导的脐血管内皮细胞凋亡失衡与肿瘤坏死因子的关系[J].中国妇幼保健,2004,19(21):29-31.
[18]王春,秦少博.炎症与血管内皮损伤研究进展[J].心血管病学进展,2015,36(1):89-92.
[19]黄卫民,陈相宜,蔡捷,等.乌司他丁拮抗炎性因子致血管内皮细胞凋亡的实验研究[J].广西医学,2016,28(12):1638-1641,1648.
[20]CHAPPELL D,HOFMANN-KIEFER K,JACOB M,et al.TNF-alpha induced shedding of the endothelial glycocalyx is prevented by hydrocortisone and antithrombin[J].Basic Res Cardiol,2009,104(1):78-89.
[21]GRUNDMANN S,FINK K,RABADZHIEVA L,et al.Perturbation of the endothelial glycocalyx in post cardiac arrest syndrome[J].Resuscitation,2012(83):715-720.
[22]BRUEGGER D,JACOB M,REHM M,et al.Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts[J].Heart Circul Physiol,2005,289(5):1993-1999.
[23]REHM M,HALLER M,ORTH V,et al.Changes in blood volume and hematocrit during acute preoperative volume loading with 5%albumin or 6%hetastarch solutions in patients before radical hysterectomy[J].Anesthesiology,2001(95):849-856.
[24]CHAPPELL D,JACOB M,HOFMANN-KIEFER K,et al.A rational approach to perioperative fluid management[J].Anesthesiology,2008,109(4):723-740.
[25]高志峰,冯艺,谷洁,等.目标导向液体治疗在腹膜后肿瘤切除术中的应用[J].中国医药,2017,12(10):1560-1564.
[26]CHAPPELL D,JACOB M,HOFMANN-KIEFER K,et al.Antithrombin reduces shedding of the endothelial glycocalyx following ischaemia/reperfusion[J].Card Res,2009,83(2):388-396.