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II. ДИАГНОСТИКА
INFLUENCE OF CARDIOPULMONARY BYPASS PERIOD TO THE SERUM LEVEL OF INFLAMMATORY MEDIATORS
UDC 616.127-089.168:617089.5
Mahmudov R.M., Mammadov V.Sh., Sad i gov T.Q.
Ministry of Health of the Republic of Azerbaijan, Central Hospital of Oil Workers, Baku, Azerbaijan
Abstract
We decided to study the mutual relation between PTX3 and TNFa levels in the blood and the time of cardiopulmonary bypass (CPB) used during the coronary artery bypass surgery on the patients with stable angina. For this purpose in Central Hospital of Oil Workers, 92 patients between the age of44-73 with diabetes mellitus with stable angina of IHDII-III functional class were examined. Also in a blood sample taken from all the patients before and after 8,24 hours of coronary artery bypass surgery PTX3, TNFa levels were recorded. The analysis of obtained results showed that PTX3 level in the blood after 24 hours of coronary artery bypass surgery is changed with increasing dynamics in the patients whose CPB time is up to 120 minutes. This dynamic change is characterized by the negative character after the CPB time exceeds 120 minutes. The results also showed that there is straight positive correlative relationship between the TNFa level in the blood and the time of CPB. All these indicate that the learning of PTX3 and TNFa level in the blood of patients who have coronary artery bypass surgery may be prognostic significance.
Keywords:
Coronary artery bypass surgery cardiopulmonary bypass, inflammatory mediators.
КАБЫНУ МЕДИАТОРЛАРЫНЫН САРЫСУЛЫКДЕНГЕЙ1НЕ ЖАСАНДЫ КАНАЙНАЛЫМ КЕЗЕН1Н1Н ЭСЕР!
Махмудов Р.М., Маммадов В.Ш., Садигов Т.К.
Азербайджан, Баку каласы, Азербайджан Республикасынын Денсаулык, сактау министрлп, Мунайшылырдын Орталык, ауруханасы.
Ацдатпа
Бiз канныц PTX3жене TNFa децгейнц эзара карым-катынасынжене туракты стенокар-диясы бар наукастарга жасалатын коронарлык шунтау кез/'ндеп жасанды кан айналым уакытын мецгеруд/' карастырдык. Орталык ауруханада анамнезнде кант диабет', туракты стенокардиясы бар, ФК ЖИА II-III 44-73 жастагы 92 мунай жумысшылары каралды. Сонымен катар, барлык пациенттен 8-24 сагат аралыгында алынган кан Yлгiлерi РТХЗ коронарлык шунтау, TNFa децгейжазылды
Алынган талдаулар нетижес бойынша Аорта-коронарлы шунтаудан 24 сагаттан кейн канда РТХ3 децгей/ КПБ уакыты 120 минутка дейн болган наукастарда динамикалык кэтерлу байкалынды. КПБ уакыты 120 минуттан асса, динамикалык эзгер'ю негативт мцездеме алады. К,анныц TNFa децгей мен Жасанды кан айналым уакыты арасаында ткелей оц корреляция-лык теуелдлк бар екендгн зерттеу нетижелерi кэрсетп Коронарлы шунттауды басынан эткерген наукастарда.
Туйш сездер:
аортокоронарлы шунттау, жасанды к,анайналым, к,абыну медиаторлары РТХ3 зерттеу жене TNFa децгей болжамдык, мацызга ие екендИ.
II. ДИАГНОСТИКА
ВЛИЯНИЕ ПЕРИОДА ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ НА СЫВОРОТОЧНЫЙ УРОВЕНЬ МЕДИАТОРОВ ВОСПАЛЕНИЯ
Махмудов Р.М., Маммадов В.Ш., Садигов Т.К.
Министерство здравоохранения Азербайджанской Республики, Центральная больница нефтяных работников, Баку, Азербайджан
Ключевые слова:
аортокоронарное шунтирование, искусственное кровообращение, медиаторы воспаления.
Аннотация
Мы решили изучить взаимоотношения между уровнями PTX3 и TNFa в крови и временем искусственного кровообращения (ИК), используемого во время коронарного шунтирования на больных со стабильной стенокардией. Для этого в Центральной больнице нефтяных работников 92 пациента в возрасте от 44-73 с сахарным диабетом со стабильной стенокардией функционального класса ИБС II-III были рассмотрены. Кроме того, в образцах крови, взятых у всех пациентов до и после 8,24 часов коронарного шунтирования РТХ3, уровни TNFa были записаны. Анализ полученных результатов показал, что уровень РТХ3 в крови через 24 часа после аортокоронарного шунтирования изменяется с увеличением динамики у пациентов, чье время КПБ составляло до 120 минут. Это динамическое изменение характеризуется негативным характером по истечении времени КПБ превышает 120 минут. Результаты также показали, что существует прямая положительная корреляционная зависимость между уровнем TNFa в крови и времени ИК Все это указывает, что изучение РТХ3 и уровня TNFa в крови пациентов, которые перенесли коронарное шунтирование, может дать прогностическое значение.
Introduction
Inflammatory reactions and inflammatory factors in the blood vessels have an important role in the formation of atherosclerosis. Chronic inflammatory reactions in endothelial layer of arteries cause to the formation of asymptomatic plaques. As a result, all of these lead to the plaque ruptures and ischemic heart disease (IHD) (1). The role of inflammatory mediators in the formation of IHD and their prognostic significance in the vessel injuries are studied widely in recent years. The increase of level of atherosclerotic biomarkers as C-reactive protein, pentarxin 3 (PTX3) and tumor necrosis factor (TNFa) in the blood and their increase cardiovascular events were indicated in numerous researches (2-6). PTX3 is similar to Creactive protein for its structural and functional characteristics, but in contrast to it PTX3 is synthesized by macrophages, endothelial cells in the inflammatory place not in the liver (7). The synthesized PTX3 by accumulating in the neutrophil granules leap to the blood due to the impact of any irritative factors and its level in the blood increases sharply (8). In addition to the increase of PTX3 level in the blood the irritative factors also cause to increase TNFa level. PTX3 and TNFa level reaching peak level in a short period unlike the C- reactive protein during the
myocardial infarction confi rms the high sensitivity of PTX3-in vessel injuries (2). The cause of using cardiopulmonary bypass (CPB) apparatus during coronary artery bypass surgery to the emergence of inflammatory reactions was shown in some studies. (9). But the mutual relation between the time of CPB used during the coronary artery bypass surgery and the levels of inflammatory mediators in the blood in patients with stable angina was not studied. By taking into account all of these we decided to study the mutual relation between PTX3 and TNFa levels in the blood and the time of CPB used during the coronary artery bypass surgery on the patients with stable angina.
Material and methods
For this purpose in Central Hospital of Oil Workers, 92 patients between the age of 44-73 with diabetes mellitus with stable angina of IHD II-III functional class were examined. Coronary artery bypass surgery in patients involved in the study process was carried out. During the operation the CPB time was recorded in all patients. Also in a blood sample taken (Central Hospital of Oil Workers, GenLab laboratory, Human, ELISA kit ) from all the patients before and after 8, 24 hours of coronary artery bypass surgery PTX3, TNFa levels were
ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 4 (36) • 2013
recorded. For conducting the statistical analysis of the results "Statistics"-computer packet was used.
Results of the study
The analysis of the study results showed that, after 24 hours of coronary artery bypass surgery the PTX3 level in the blood were high in the patients whose CPB time is between 61-120 minutes (p<0,05). In the blood of patients whose CPB time is more than 120 minutes the PTX3 level is lower in comparison with the patients whose CPB time is between 61-120 minutes.
After 24 hours of surgery in the blood of patients whose CPB time is more than 120 minutes the PTX3 level was lower in comparison with the ones whose CPB time is between 61-120 minutes. The mutual relation between PTX3 level in the blood and the time of CPB was shown in Figure 1.
Also the interaction between the increase of CPB time and TNFa level was observed. The obtained results showed that the highest TNFa level in the blood after 8 and 24 hours of surgery was observed in the patients whose CPB time was more than 120 minutes. (p>0,05). At the same time TNFa level was higher in the blood of patients whose CPB time is between 61-120 minutes in compariosn with the patients whose CPB time is lower than 60 minutes. But these changes were not statistically correct. The interaction between TNFa level in the blood and CPB time was shown in Figure 2.
Discussion
The analysis of obtained results showed that PTX3 level in the blood after 24 hours of coronary
artery bypass surgery is changed with increasing dynamics in the patients whose CPB time is up to 120 minutes. This dynamic change is characterized by the negative character after the CPB time exceeds 120 minutes. The results also showed that there is straight positive correlative relationship between the TNFa level in the blood and the time of CPB. There are small number of studies in the literature related to this subject. So that, the impact of CPB on PTX3 level in the blood of patients who have artery bypass surgery was learned in the research conducted by Kunes and his contributors. The results showed that the use of artificial blood circulation apparatus in the patients with coronary artery bypass surgery causes to the increase of PTX3 level in the blood (9).
The main part of the research conducted by us which awakens interest is the observation of negative dynamics in the PTX3 level in the blood after 24 hours of surgery in the patients whose CPB time is more than 120 minutes. This shows the influence of the increase of CPB time to the response reaction of organism in the level of inflammatory mediators. At the same time the increase of TNFa level in the blood of patients whose CPB time is more than 120 minutes indicates the negative impacts of artifical blood circulation apparatus on the organism. It is known that the complications after the surgery becomes more in the patients with coronary artery bypass surgery whose CPB time becomes longer. All these indicate that the learning of PTX3 and TNFa level in the blood of patients who have coronary artery bypass surgery may be prognostic significance.
References
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2. Peri G., Introna M., Corradi D., et al. PTX3, A prototypical long pentraxin, is an early indicator of acute myocardial infarction in humans. Circulation 2000; 102:636-41.
3. Latini R, Maggioni A P, Peri G et al. Prognostic significance of the long pentraxin PTX3 in acute myocardial infarction. Circulation 2004; 110:2349-54.
4. Suzuki S., Takeishi Y., Niizeki T., et al. Pentraxin 3, a new marker for vascular inflammation, predicts adverse clinical outcomes in patients with heart failure. Am Heart J 2008; 155:75-81.
5. Libby P., Willerson J.T., Braunwald E. Creactive protein and coronary heart disease. N Engl J Med
Figure 1
The mutual relation between PTX3 level in the blood and the time of cardiopulmonary bypass.
Figure 2
The interaction between TNFa level in the blood and the time of cardiopulmonary bypass.
2004; 351:295-8; author reply 295-298.
6. Kotooka N., Inoue T., Aoki S., et al. Prognostic value of pentraxin 3 in patients with chronic heart failure. Int J Cardiol 2008; 130:19- 22.
7. Bottazzi B., Garlanda C., Cotena A., et al. The long pentraxin PTX3 as a prototypic humoral pattern recognition receptor: interplay with cellular innate immunity. Immunol Rev 2009; 227:9-18.
8. JaiLLon S., Peri G., Delneste Y., et al. The humoral
pattern recognition receptor PTX3 is stored in neutrophiL granuLes and LocaLizes in extracellular traps. J Exp Med 2007; 204:793-804. 9. Kunes P., Lonsky V., Mandak J., et al. The Long pentraxin 3 in cardiac surgery: distinct responses in "on-pump" and "offpump" patients. Scandinavian Cardiovascular Journal, vol. 41, no. 3, pp. 171-179, 2007.
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