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A comparative study of the immune modulating properties of antifibrinolytics in cardiac surgery

机译：抗纤溶酶在心脏外科手术中免疫调节特性的比较研究

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Purpose: Antifibrinolytics, used in cardiac surgery to abate postoperative blood loss, share anti-inflammatory properties by suppression of pro-inflammatory D-dimer and plasmin levels. Additional drug specific immune modulating qualities are often mentioned in the discussion on which antifibrinolytic can best be used. To determine the extent and relevance of these effects, we investigated cytokine and growth factor plasma levels in cardiac surgery patients randomized to receive either tranexamic acid, aprotinin, or placebo. Corticosteroid-treated patients served to put the effects in perspective. Methods: Using a biochip immunoassay, plasma of 36 cardiac surgery patients was quantified for 12 cytokines and growth factors, assessed preoperatively and 6, 12, 24, and 48. h after the start of cardiopulmonary bypass. Eight patients were treated with tranexamic acid, nine with aprotinin, and nine received placebo. Ten placebo-treated patients received corticosteroids. Results: IL-1?, IL-6, IL-8, IL-10, IFN-??, TNF-??, VEGF, MCP-1, and EGF plasma concentrations significantly changed over time across all patients. Aprotinin-treated patients showed decreased pro-inflammatory TNF-?? and peak MCP-1 plasma levels when compared with placebo. However, corticosteroids attenuated the inflammatory response to a much larger extent, lowering postoperative IL-6, IL-10, IFN-??, and VEGF concentrations also. Conclusions: Aprotinin attenuates postoperative pro-inflammatory levels TNF-?? and MCP-1 whereas tranexamic acid does not. The majority of plasma proteins studied, however, were not affected by the use of antifibrinolytics when compared with placebo. A clinically relevant common anti-inflammatory effect through inhibition of fibrinolysis seems therefore unlikely. ? 2012 Elsevier Ltd.
机译：目的：抗纤维蛋白溶解剂，用于心脏外科手术以减轻术后失血，通过抑制促炎性D-二聚体和纤溶酶水平来共享抗炎特性。在讨论中最好使用抗纤维蛋白溶解药物的讨论中经常提到其他药物特异性免疫调节质量。为了确定这些作用的程度和相关性，我们调查了随机接受氨甲环酸，抑肽酶或安慰剂治疗的心脏外科手术患者的细胞因子和生长因子血浆水平。接受皮质类固醇激素治疗的患者可以很好地了解这种作用。方法：使用生物芯片免疫测定法，对36例心脏外科手术患者的血浆中12种细胞因子和生长因子进行了定量，并在术前以及体外循环开始后6、12、24和48 h进行了评估。八例患者接受氨甲环酸治疗，九例接受抑肽酶治疗，九例接受安慰剂治疗。十名接受安慰剂治疗的患者接受了皮质类固醇激素治疗。结果：在所有患者中，IL-1α，IL-6，IL-8，IL-10，IFN-α，TNF-α，VEGF，MCP-1和EGF血浆浓度随时间显着变化。抑肽酶治疗的患者显示促炎性TNF-α降低与安慰剂比较时的MCP-1血浆峰值水平。然而，皮质类固醇在很大程度上减弱了炎症反应，降低了术后IL-6，IL-10，IFN-γ和VEGF的浓度。结论：抑肽酶可减轻术后炎症反应前TNF-α的水平。和MCP-1，而氨甲环酸则没有。但是，与安慰剂相比，研究的大多数血浆蛋白不受抗纤溶酶作用的影响。因此，似乎不太可能通过抑制纤维蛋白溶解而产生临床相关的常见抗炎作用。 ？ 2012爱思唯尔有限公司

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