小儿主动脉缩窄围术期泛素羧基末端水解酶L1的变化与临床意义

doi:10.3969/j.issn.1006-7795.2018.03.024

摘要/Abstract

摘要： 目的观察体外循环（cardiopulmonary bypass，CPB）和非CPB下行手术的主动脉缩窄患儿中血清泛素羧基末端水解酶L1（ubiquitin carboxyl-terminal esterase-L1，UCH-L1）浓度变化，评价UCH-L1是否是一个主动脉弓部手术后CPB相关脑损伤的预测指标。方法 2012年1月和2013年6月首都医科大学附属北京儿童医院共39例主动脉缩窄患儿接受了主动脉成型手术；其中A组17例未行CPB，B组22例应用选择性脑灌注分别在6个时间点（麻醉诱导后，关胸，术后2、8、24、48 h）收集血清标本，采用酶联免疫吸附法分别测定UCH-L1、神经胶质蛋白S-100β和神经元特异性烯醇化酶（neuron specific enolase，NSE）浓度。在术后8 h，拔除气管插管后6 h和出院前进行神经系统功能评分。结果 2组血清中UCH-L1浓度在术前基本相同[A组（0.184±0.066）μg/L vs B组（0.194±0.067）μg/L]。B组术后2 h后血清UCH-L1浓度较A组明显升高[A组（0.238±0.067）μg/L vs B组（0.327±0.151）μg/L，P<0.05]，并于术后8 h达到高峰。在术后24 h，2组血清UCH-L1浓度差异无统计学意义[A组（0.208±0.078）μg/L vs B组（0.201±0.081）μg/L，P>0.05]。B组血清UCH-L1的峰值浓度和CPB时间明显相关（r=0.575，P=0.005）。术后所有患者均未出现持续存在的严重神经系统合并症。结论与非CPB手术相比，应用选择性脑灌注的小儿主动脉弓部手术可引起血清UCH-L1浓度显著升高，并且与CPB时间密切相关。UCH-L1可以作为一个CPB相关脑损伤诊断的潜在生物标志物。

关键词: 主动脉缩窄, 大脑, 泛素羧基末端水解酶L1, S100β, 神经元特异性烯醇化酶

Abstract: Objective To examine serum ubiquitin carboxyl-terminal esterase-L1 (UCH-L1) levels in coarctation patients with and without cardiopulmonary bypass(CPB), and to evaluate whether UCH-L1 was a useful marker in predicting the brain injury associated with CPB after aortic arch operation.Methods Thirty-nine consecutive patients subjected to aortic repairs were enrolled, 22 patients received SCP(group B) and 17 did not receive CPB(group A). Serum was collected at six time points (after induction of anesthesia; closure of chest; 2 h, 8 h, 24 h, 48 h after operation). UCH-L1, S100β and neuron specific enolase (NSE) levels were measured by using a sandwich enzyme-linked immunosorbent assay. Neurologic function scores were recorded at 8 h after operation,6 h after extubation and before discharge.Results Baseline UCH-L1 protein levels in serum were similar to those of all groups[group A (0.184±0.066) μg/L, group A (0.194±0.067) μg/L. The concentrations of UCH-L1 in group B were elevated at 2 hours after operation significantly compared with group A[group A (0.238±0.067) μg/L vs group B (0.327±0.151) μg/L, P<0.05]and reached a peak at 8 h after operation. At 24 hours after operation, levels of UCH-L1 had no significant differences between the two groups[group A (0.208±0.078) μg/L vs group B(0.201±0.081) μg/L, P>0.05]. The correlation between CPB time and peak concentrations of UCH-L1 in group B was found to be statistically significant (r=0.575, P=0.005). Permanent neurological complications were not detected in all patients after operation.Conclusion Pediatric operation of the aortic arch with SCP causes a significantly greater increase in UCH-L1 serum levels than those of off-pump surgery and correlates with CPB duration. UCH-L1 can be a potential useful biomarker for the prediction of brain injury after CPB.

Key words: coarctation, brain, ubiquitin carboxyl-terminal esterase-L, S100β, neuron specific enolase

中图分类号:

R743.3

童峰, 李磊, 赵涛, 李晓峰, 刘迎龙. 小儿主动脉缩窄围术期泛素羧基末端水解酶L1的变化与临床意义[J]. 首都医科大学学报, 2018, 39(3): 444-448.

Tong Feng, Li Lei, Zhao Tao, Li Xiaofeng, Liu Yinglong. Observation of changing of perioperative serum ubiquitin carboxyl-terminal esterase-L1 in children with aortic coarctation[J]. Journal of Capital Medical University, 2018, 39(3): 444-448.

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