Dynamic changes and clinical significance of LXA4 in the perioperative period of cardiopulmonary bypass

Dynamic changes and clinical significance of LXA4 in the perioperative period of cardiopulmonary bypass (Free)

 

Abstract

Dynamic changes in lipoxin A4 (LXA4) in child patients with congenital heart disease (CHD), in the perioperative period of cardiopulmonary bypass (CPB) were studied. Peripheral blood was collected from 16 child patients (CPB group) before operation (Tc), after operation (T0), at 1 day after operation (T1), at 3 days after operation (T3), and at 7 days after operation (T7); and from 17 children with no CHD (control group). The level of LXA4 in peripheral blood was detected via enzyme-linked immunosorbent assay (ELISA). Clinical data of the child patients were collected. The white blood cell (WBC) count, the proportion of neutrophils (N%) and high-sensitivity C-reactive protein (hs-CRP) levels were also detected, followed by statistical analysis. The plasma LXA4 levels in CPB group at Tc were significantly lower compared to that in the control group (P<0.01). In CPB group, the level of LXA4 showed an increasing trend at T0, WBC and hs-CRP were transiently increased at T0 and increased most significantly at T1. N% was obviously increased at T0 compared to that at Tc and was still significantly higher at T7 compared to that at Tc. The CPB time and aortic clamping time were positively correlated with the time in the Pediatric Intensive Care Unit (PICU), the application time of ventilator, and the hs-CRP level at T0. The LXA4 level at each time-point had no correlation with other indexes. In conclusion, the inflammatory response after CPB increases the synthesis of LXA4 with an anti-inflammatory effect, but LXA4 cannot be used as a sensitive index for monitoring inflammation.

Keywords: congenital heart disease, cardiopulmonary bypass, lipoxin A4

Introduction

Congenital heart disease (CHD) is a common congenital developmental malformation in pediatrics. Cardiopulmonary bypass (CPB) is a representative technique of cardiac surgery, and it has been increasingly improved and widely popularized in recent years. However, CPB is an invasive treatment, whose postoperative complications, such as postoperative infection, low cardiac output syndrome, heart failure, arrhythmia and bleeding, should be paid enough attention to. The surgical trauma, low temperature, ischemia reperfusion and the contact with the surface of artificial materials, such as the artificial tube during CPB, can activate the immune system in the body, lead to activation of inflammatory cells, coagulation system, complement system, white blood cells (WBCs) and platelets, and release inflammatory factors (13). Lipoxin A4 (LXA4), as an important endogenous anti-inflammatory mediator, can reduce the production of inflammatory factors and inhibit the activation and chemotaxis of neutrophils (4). This study compared the LXA4 levels between child patients with CHD and non-CHD children, observed the dynamic changes of LXA4 in the perioperative period of CPB, and analyzed its correlation with blood routine indexes, high-sensitivity C-reactive protein (hs-CRP) and other clinical indexes, so as to find the correlation between LXA4 and the inflammatory response of CHD.

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