體外循環(extracorporeal circulation,ECC)是心臟直視手術不可或缺的輔助及治療手段。但同時,ECC 帶來的全身炎癥反應及多器官損傷也給臨床提出了挑戰。急性腎損傷(acute kidney injury,AKI)是 ECC 術后主要的并發癥及死亡原因之一,不僅增加住院時間和住院費用,還明顯增加術后患者的病死率,極大地威脅著臨床患者的預后。然而,目前國內外針對 ECC 相關 AKI 的治療手段十分有限,主要集中于圍手術期藥物使用及腎替代治療等對癥支持治療兩個方面。盡管目前的治療大多集中于 AKI 的損傷期,內源性細胞修復及以細胞為基礎的治療方案受到越來越多的重視。最新的研究發現干細胞在ECC相關腎損傷的修復過程中發揮著重要的作用。該文對 ECC 相關 AKI 與干細胞治療研究進展進行了綜述。
Citation:
趙俊飛, 安琪.
Copyright ? the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
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| 2. | Mangano CM, Diamondstone LS, Ramsay JG, et al. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med, 1998, 128(3): 194-203. |
| 3. | Abel RM, Buckley MJ, Austen WG, et al. Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg, 1976, 71(3): 323-333. |
| 4. | Gailiunas P Jr, Chawla R, Lazarus JM, et al. Acute renal failure following cardiac operations. J Thorac Cardiovasc Surg, 1980, 79(2): 241-243. |
| 5. | Ostermann ME, Taube D, Morgan CJ, et al. Acute renal failure following cardiopulmonary bypass: a changing picture. Intensive Care Med, 2000, 26(5): 565-571. |
| 6. | Andersson LG, Ekroth R, Bratteby LE, et al. Acute renal failure after coronary surgery--a study of incidence and risk factors in 2009 consecutive patients. Thorac Cardiovasc Surg, 1993, 41(4): 237-241. |
| 7. | Zanardo G, Michielon P, Paccagnella A, et al. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg, 1994, 107(6): 1489-1495. |
| 8. | Mangos GJ, Brown MA, Chan WY, et al. Acute renal failure following cardiac surgery: Incidence, outcomes and risk factors. Aust N Z J Med, 1995, 25(4): 284-289. |
| 9. | Antunes PE, Prieto D, Ferr?o de Oliveira J, et al. Renal dysfunction after myocardial revascularization. Eur J Cardiothorac, 2004, 25(4): 597-604. |
| 10. | Yeboah ED, Petrie A, Pead JL. Acute renal failure and open heart surgery. Br Med J, 1972, 1(5797): 415-418. |
| 11. | Bhat JG, Gluck MC, Lowenstein J, et al. Renal failure after open heart surgery. Ann Intern Med, 1976, 84(6): 677-682. |
| 12. | Hilberman M, Myers BD, Carrie BJ, et al. Acute renal failure following cardiac surgery. J Thorac Cardiovasc Surg, 1979, 77(6): 880-888. |
| 13. | Corwin HL, Sprague SM, Delaria GA, et al. Acute renal failure associated with cardiac operations. A case-control study. J Thorac Cardiovasc Surg, 1989, 98(6): 1107-1112. |
| 14. | Schmitt H, Riehl J, Boseilla A, et al. Acute renal failure following cardiac surgery: pre-and perioperative clinical features. Contrib Nephrol, 1991(93): 98-104. |
| 15. | Chertow GM, Levy EM, Hammermeister K, et al. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med, 1998, 104(4): 343-348. |
| 16. | 急性腎損傷專家共識小組. 急性腎損傷診斷與分類專家共識. 中華腎臟病雜志, 2006, 22(11): 661-663. |
| 17. | Grayson AD, Khater M, Jackson M, et al. Valvular heart operation is an Independent risk factor for acute renal failure. Ann Thorac Sutg, 2003, 75(6): 1829-1835. |
| 18. | Elahi M, Asopa S, Pflueger A, et al. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg, 2009, 35(5): 854-863. |
| 19. | Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol, 2004, 15(6): 1597-1605. |
| 20. | Mancini E, Caramelli F, Ranucci M, et al. Is time on cardiopulmonary bypass during cardiac surgery associated with acute kidney injury requiring dialysis?. Hemodial Int, 2012, 16(2): 252-258. |
| 21. | Moran SM, Myers BD. Pathophysiology of protracted acute renal failure in man. J Clin Invest, 1985, 76(4): 1440-1448. |
| 22. | Parolari A, Alamanni F, Gherli T, et al. Cardiopulmonary bypass and oxygen consumption: oxygen delivery and hemodynamcs. Ann Thorac Surg, 1999, 67(5): 1320-1327. |
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| 24. | Rudy LW Jr, Heymann MA, Edmunds LH Jr. Distribution of systemic blood flow during cardiopulmonary bypass. J Appl Physiol, 1973, 34(2): 194-200. |
| 25. | Harris EA, Seelye ER, Barratt-Boyes BG. On the availability of oxygen to the body during cardiopulmonary bypass in man. Br J Anaesth, 1974, 46(6): 425-431. |
| 26. | Urzua J, Troncoso S, Bugedo G, et al. Renal function and cardiopulmonary bypass: effect of perfusion pressure. J Cardiothorac Vasc Anesth, 1992, 6(3): 299-303. |
| 27. | Fransen E, Maessen J, Dentener M, et al. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest, 1998, 113(5): 1290-1295. |
| 28. | Asimakopoulos G, Taylor KM. Effects of cardiopulmonary bypass on leukocyte and endothelial adhesion molecules. Ann Thorac Surg, 1998, 66(6): 2135-2144. |
| 29. | Gali?anes M, Watson C, Trivedi U, et al. Differential patterns of neutrophil adhesion molecules during cardiopulmonary bypass in humans. Circulation, 1996, 94(Suppl 9): 364-369. |
| 30. | Zilla P, Fasol R, Groscurth P, et al. Blood platelets in cardiopulmonary bypass operations. Recovery occurs after initial stimulation, rather than continual activation. J Thorac Cardiovasc Surg, 1989, 97(3): 379-88. |
| 31. | Haga Y, Hatori N, Yoshizu H, et al. Granulocyte superoxide anion and elastase release during cardiopulmonary bypass. Artif Organs, 1993, 17(10): 837-842. |
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| 34. | Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002, 21(2): 232-244. |
| 35. | Rustom R, Grime S, Maltby P, et al. Observations on the early renal uptake and later tubular metabolism of radiolabelled aprotinin (Trasylol) in man: theoretical and practical considerations. Clin Sci (Lond), 1993, 84(2): 231-235. |
| 36. | Kramer J, Moch T, Von Sicherer L, et al. Effects of aprotinin on renal function and urinary prostaglandin excretion in conscious rats after acute salt loading. Clin Sci (Lond), 1979, 56(6): 547-553. |
| 37. | Mora Mangano CT, Neville MJ, Hsu PH, et al. Aprotinin, blood loss, and renal dysfunction in deep hypothermic circulatory arrest. Circulation, 2001, 104(Suppl 12): I247-I255. |
| 38. | Molenaar IQ, Begliomini B, Grazi GL, et al. The effect of aprotinin on renal function in orthotopic liver transplantation. Transplantation, 2001, 71(2): 247-252. |
| 39. | Musial J, Niewiarowski S, Hershock D, et al. Loss of fibrinogen receptors from the platelet surface during simulated extracorporeal circulation. J Lab Clin Med, 1985, 105(4): 514-522. |
| 40. | Kirklin JK, Westaby S, Blackstone EH, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1983, 86(6): 845-857. |
| 41. | Burne-Taney MJ, Rabb H. The role of adhesion molecules?and T cells in ischemic renal injury. Curr Opin Nephrol Hypertens, 2003, 12(1): 85-90. |
| 42. | Sheridan AM, Bonventre JV. Cell biology and molecular?mechanisms of injury in ischemic acute renal failure. Curr Opin Nephrol Hypertens, 2000, 9(4): 427-434. |
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- 1. Conlon PJ, Stafford-Smith M, White WD, et al. Acute renal failure follow-ing cardiac surgery. Nephrol Dial Transplant, 1999, 14(5): 1158-1162.
- 2. Mangano CM, Diamondstone LS, Ramsay JG, et al. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med, 1998, 128(3): 194-203.
- 3. Abel RM, Buckley MJ, Austen WG, et al. Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg, 1976, 71(3): 323-333.
- 4. Gailiunas P Jr, Chawla R, Lazarus JM, et al. Acute renal failure following cardiac operations. J Thorac Cardiovasc Surg, 1980, 79(2): 241-243.
- 5. Ostermann ME, Taube D, Morgan CJ, et al. Acute renal failure following cardiopulmonary bypass: a changing picture. Intensive Care Med, 2000, 26(5): 565-571.
- 6. Andersson LG, Ekroth R, Bratteby LE, et al. Acute renal failure after coronary surgery--a study of incidence and risk factors in 2009 consecutive patients. Thorac Cardiovasc Surg, 1993, 41(4): 237-241.
- 7. Zanardo G, Michielon P, Paccagnella A, et al. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg, 1994, 107(6): 1489-1495.
- 8. Mangos GJ, Brown MA, Chan WY, et al. Acute renal failure following cardiac surgery: Incidence, outcomes and risk factors. Aust N Z J Med, 1995, 25(4): 284-289.
- 9. Antunes PE, Prieto D, Ferr?o de Oliveira J, et al. Renal dysfunction after myocardial revascularization. Eur J Cardiothorac, 2004, 25(4): 597-604.
- 10. Yeboah ED, Petrie A, Pead JL. Acute renal failure and open heart surgery. Br Med J, 1972, 1(5797): 415-418.
- 11. Bhat JG, Gluck MC, Lowenstein J, et al. Renal failure after open heart surgery. Ann Intern Med, 1976, 84(6): 677-682.
- 12. Hilberman M, Myers BD, Carrie BJ, et al. Acute renal failure following cardiac surgery. J Thorac Cardiovasc Surg, 1979, 77(6): 880-888.
- 13. Corwin HL, Sprague SM, Delaria GA, et al. Acute renal failure associated with cardiac operations. A case-control study. J Thorac Cardiovasc Surg, 1989, 98(6): 1107-1112.
- 14. Schmitt H, Riehl J, Boseilla A, et al. Acute renal failure following cardiac surgery: pre-and perioperative clinical features. Contrib Nephrol, 1991(93): 98-104.
- 15. Chertow GM, Levy EM, Hammermeister K, et al. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med, 1998, 104(4): 343-348.
- 16. 急性腎損傷專家共識小組. 急性腎損傷診斷與分類專家共識. 中華腎臟病雜志, 2006, 22(11): 661-663.
- 17. Grayson AD, Khater M, Jackson M, et al. Valvular heart operation is an Independent risk factor for acute renal failure. Ann Thorac Sutg, 2003, 75(6): 1829-1835.
- 18. Elahi M, Asopa S, Pflueger A, et al. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg, 2009, 35(5): 854-863.
- 19. Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol, 2004, 15(6): 1597-1605.
- 20. Mancini E, Caramelli F, Ranucci M, et al. Is time on cardiopulmonary bypass during cardiac surgery associated with acute kidney injury requiring dialysis?. Hemodial Int, 2012, 16(2): 252-258.
- 21. Moran SM, Myers BD. Pathophysiology of protracted acute renal failure in man. J Clin Invest, 1985, 76(4): 1440-1448.
- 22. Parolari A, Alamanni F, Gherli T, et al. Cardiopulmonary bypass and oxygen consumption: oxygen delivery and hemodynamcs. Ann Thorac Surg, 1999, 67(5): 1320-1327.
- 23. Kirklin JW, Barratt Boyes BG. Cardiac Surgery. 2nd Ed. New York, Churchill Livingstone, 1993: 80.
- 24. Rudy LW Jr, Heymann MA, Edmunds LH Jr. Distribution of systemic blood flow during cardiopulmonary bypass. J Appl Physiol, 1973, 34(2): 194-200.
- 25. Harris EA, Seelye ER, Barratt-Boyes BG. On the availability of oxygen to the body during cardiopulmonary bypass in man. Br J Anaesth, 1974, 46(6): 425-431.
- 26. Urzua J, Troncoso S, Bugedo G, et al. Renal function and cardiopulmonary bypass: effect of perfusion pressure. J Cardiothorac Vasc Anesth, 1992, 6(3): 299-303.
- 27. Fransen E, Maessen J, Dentener M, et al. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest, 1998, 113(5): 1290-1295.
- 28. Asimakopoulos G, Taylor KM. Effects of cardiopulmonary bypass on leukocyte and endothelial adhesion molecules. Ann Thorac Surg, 1998, 66(6): 2135-2144.
- 29. Gali?anes M, Watson C, Trivedi U, et al. Differential patterns of neutrophil adhesion molecules during cardiopulmonary bypass in humans. Circulation, 1996, 94(Suppl 9): 364-369.
- 30. Zilla P, Fasol R, Groscurth P, et al. Blood platelets in cardiopulmonary bypass operations. Recovery occurs after initial stimulation, rather than continual activation. J Thorac Cardiovasc Surg, 1989, 97(3): 379-88.
- 31. Haga Y, Hatori N, Yoshizu H, et al. Granulocyte superoxide anion and elastase release during cardiopulmonary bypass. Artif Organs, 1993, 17(10): 837-842.
- 32. Faymonville ME, Pincemail J, Duchateau J, et al. Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans. J Thorac Cardiovasc Surg, 1991, 102(2): 309-317.
- 33. Frering B, Philip I, Dehoux M, et al. Circulating cytokines in patients undergoing normothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1994, 108(4): 636-41.
- 34. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002, 21(2): 232-244.
- 35. Rustom R, Grime S, Maltby P, et al. Observations on the early renal uptake and later tubular metabolism of radiolabelled aprotinin (Trasylol) in man: theoretical and practical considerations. Clin Sci (Lond), 1993, 84(2): 231-235.
- 36. Kramer J, Moch T, Von Sicherer L, et al. Effects of aprotinin on renal function and urinary prostaglandin excretion in conscious rats after acute salt loading. Clin Sci (Lond), 1979, 56(6): 547-553.
- 37. Mora Mangano CT, Neville MJ, Hsu PH, et al. Aprotinin, blood loss, and renal dysfunction in deep hypothermic circulatory arrest. Circulation, 2001, 104(Suppl 12): I247-I255.
- 38. Molenaar IQ, Begliomini B, Grazi GL, et al. The effect of aprotinin on renal function in orthotopic liver transplantation. Transplantation, 2001, 71(2): 247-252.
- 39. Musial J, Niewiarowski S, Hershock D, et al. Loss of fibrinogen receptors from the platelet surface during simulated extracorporeal circulation. J Lab Clin Med, 1985, 105(4): 514-522.
- 40. Kirklin JK, Westaby S, Blackstone EH, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1983, 86(6): 845-857.
- 41. Burne-Taney MJ, Rabb H. The role of adhesion molecules?and T cells in ischemic renal injury. Curr Opin Nephrol Hypertens, 2003, 12(1): 85-90.
- 42. Sheridan AM, Bonventre JV. Cell biology and molecular?mechanisms of injury in ischemic acute renal failure. Curr Opin Nephrol Hypertens, 2000, 9(4): 427-434.
- 43. Lassnigg A, Donner E, Grubhofer G, et al. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol, 2000, 11(1): 97-104.
- 44. Mahesh B, Yim B, Robson D, et al. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg, 2008, 33(3): 370-376.
- 45. Friedrich JO1, Adhikari N, Herridge MS, et al. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med, 2005, 142(7): 510-524.
- 46. Tang AT, El-Gamel A, Keevil B, et al. The effect of “renal-dose” dopamine on renal tubular function following cardiac surgery: assessed by measuring retinol binding protein (RBP). Eur J Cardiothorac Surg, 1999, 15(5): 717-721.
- 47. Caimmi PP, Pagani L, Micalizzi E, et al. Fenoldopam for renal protection in patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2003, 17(4): 491-494.
- 48. Bove T, Landoni G, Calabrò MG, et al. Renoprotective action of fenoldopam in high-risk patients undergoing cardiac surgery: a prospective, double-blind, randomized clinical trial. Circulation, 2005, 111(24): 3230-3235.
- 49. H?rbelt M, Lee SY, Mang HE, et al. Acute and chronic microvascular alterations in a mouse model of ischemic acute kidney injury. Am J Physiol Renal Physiol, 2007, 293(3): F688-F695.
- 50. Maeshima A, Yamashita S, Nojima Y. Identification of renal progenitor-like tubular cells that participate in the regeneration processes of the kidney. J Am Soc Nephrol, 2003, 14(12): 3138-3146.
- 51. Duffield JS, Park KM, Hsiao LL, et al. Restoration of tubular epithelial cells during repair of the postischemic kidney occurs independently of bone marrow-derived stem cells. J Clin Invest, 2005, 115(7): 1743-1755.
- 52. Lin F, Moran A, Igarashi P. Intrarenal cells, not bone marrow-derived cells, are the major source for regeneration in postischemic kidney. J Clin Invest, 2005, 115(7): 1756-1764.
- 53. Oliver JA, Maarouf O, Cheema FH, et al. The renal papilla is a niche for adult kidney stem cells. J Clin Invest, 2004, 114(6): 795-804.
- 54. Sagrinati C. Isolation and characterization of multipotent progenitor cells from the Bowman’s capsule of adult human kidneys. J Am Soc Nephrol, 2006, 17(9): 2443-2456.
- 55. Romagnani P, Kalluri R. Possible mechanisms of kidney repair. Fibrogenesis Tissue Repair, 2009, 2(1): 3.
- 56. Ronconi E, Sagrinati C, Angelotti ML, et al. Regeneration of glomerular podocytes by human renal progenitors. J Am Soc Nephrol, 2009, 20(2): 322-332.
- 57. Appel D, Kershaw DB, Smeets B, et al. Recruitment of podocytes from glomerular parietal epithelial cells. J Am Soc Nephrol, 2009, 20(2): 333-343.
- 58. Lagaaij EL, Cramer-Knijnenburg GF, Van Kemenade FJ, et al. Endothelial cell chimerism after renal transplantation and vascular rejection. Lancet, 2001, 357(9249): 33-37.
- 59. Prodromidi EI, Poulsom R, Jeffery R, et al. Bone marrow-derived cells contribute to podocyte regeneration and amelioration of renal disease in a mouse model of Alport syndrome. Stem Cells, 2006, 24(11): 2448-2455.
- 60. Sugimoto H, Mundel TM, Sund M, et al. Bone-marrow-derived stem cells repair basement membrane collagen defects and reverse genetic kidney disease. Proc Natl Acad Sci USA, 2006, 103(19): 7321-7326.
- 61. Yokoo T, Ohashi T, Utsunomiya Y, et al. Prophylaxis of antibody-induced acute glomerulonephritis with genetically modified bone marrow-derived vehicle cells. Hum Gene Ther, 1999, 10(16): 2673-2678.
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