microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2018-17-1-39-44microcirculation-149Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ (КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ)ORIGINAL ARTICLES (CLINICAL INVESTIGATIONS)Определение уровня ядерной ДНК в плазме крови кардиохирургических больных позволяет прогнозировать вероятность развития полиорганной дисфункцииEvaluation of nuclear DNA level in plasma of cardiac-surgery patients as a predictor of multiorgan dysfunctionГребенчиковО. А.GrebenchikovO. A.oleg.grebenchikov@yandex.ruСкрипкинЮ. В.SkripkinYu. V.skripkin62@gmail.ruЗабелинаТ. С.ZabelinaT. S.tatazabelina@mail.ruЛихванцевВ. В.LikhvantsevV. V.lik0704@gmail.comГосударственное бюджетное учреждение здравоохранения Московской области «Московский областной научно-исследовательский клинический институт им. М. Ф. Владимирского»РоссияMoscow Regional Clinical and Research InstituteRussian Federation2018300320181713944Copyright © Гребенчиков О.А., Скрипкин Ю.В., Забелина Т.С., Лихванцев В.В., 20182018Гребенчиков О.А., Скрипкин Ю.В., Забелина Т.С., Лихванцев В.В.Grebenchikov O.A., Skripkin Y.V., Zabelina T.S., Likhvantsev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/149

Цель - изучить значимость уровня ядерной ДНК (яДНК) в плазме пациентов после кардиохирургических вмешательств для прогнозирования развития острого почечного повреждения (ОПП), острой сердечной недостаточности (ОСН) и системной воспалительной реакции (СВР). Материал и методы. Проведено проспективное пилотное обсервационное когортное исследование уровня яДНК в плазме крови у 69 кардиохирургических больных и развития осложнений. Результаты. Уровень яДНК в крови максимально возрастал через 12 ч после операции. Уровень яДНК>20,5 нг/мл через 12 ч после операции может быть предиктором риска развития СВР (чувствительность/специфичность - 56/75 %); >17,9 нг/мл - риска ОПП (79/69 %) и ОСН (62/58 %). Выводы. Уровень яДНК может быть предиктором осложнений раннего послеоперационного периода в кардиохирургии.

The purpose of the study: to assess the significance of the nDNA plasma level in patients after cardiac surgery to predict the development of acute heart failure (AHF), acute kidney injury (AKI) and SIRS. Material and methods. The present prospective observational pilot cohort study of nDNA plasma level and the development of complications. Results. The nDNA plasma level was maximal 12 h after surgery. The level of nDNA > 20.5 ng/ml 12 h after surgery can predict risk of SIRS (sensitivity/specificity - 56/75 %); > 17.9 ng/ml - risk of AKI (79/69 %) and the AHF (62/58 %). Conclusion. The nDNA plasma level may be a predictor of early complications after cardiac surgery.

кардиохирургияпослеоперационные осложненияяДНКострое почечное повреждениесистемная воспалительная реакцияcardiac surgerypostoperative complicationsnuclear DNA (nDNA)acute kidney injury (AKI)SIRSReferencesХубутия М. Ш., Шабанов А. К., Скулачев М. В. и др. Митохондриальная и ядерная ДНК у пострадавших с тяжелой сочетанной травмой // Общая реаниматология. - 2013. - № 9(6). - С. 24 [Khubutia M.S., Shabanov A.K., Skulachev M.V. et al. Mitochondrial and Nuclear DNA in Patients with Severe Polytrauma. General Reanimatology. 2013;9(6):24. doi:10.15360/1813-9779-2013-6-24 (In Russ)].Хубутия М. Ш., Шабанов А. К., Скулачев М. В. и др. Митохондриальная и ядерная ДНК у пострадавших с тяжелой сочетанной травмой // Общая реаниматология. - 2013. - № 9(6). - С. 24 [Khubutia M.S., Shabanov A.K., Skulachev M.V. et al. Mitochondrial and Nuclear DNA in Patients with Severe Polytrauma. General Reanimatology. 2013;9(6):24. doi:10.15360/1813-9779-2013-6-24 (In Russ)].ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol. 2014;31(10):517-73. doi: 10.1093/eurheartj/ehu282.ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol. 2014;31(10):517-73. doi: 10.1093/eurheartj/ehu282.ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616-664. doi: 10.1093/ejcts/ezx324.ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616-664. doi: 10.1093/ejcts/ezx324.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis // Crit Care Med. 1992;20(6):864-874. doi: 10.1097/00003246-199206000-00025.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis // Crit Care Med. 1992;20(6):864-874. doi: 10.1097/00003246-199206000-00025.Bellomo R, Ronco C, Kellum JA et al. Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference ofthe Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-12. doi: 10.1186/cc2872.Bellomo R, Ronco C, Kellum JA et al. Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference ofthe Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-12. doi: 10.1186/cc2872.Borissoff JI, Joosen IA, Versteylen MO et al. Elevated levels of circulating DNA and chromatin are independently associated with severe coronary atherosclerosis and a prothrombotic state. Arterioscler Thromb Vasc Biol. 2013;33(8):2032-2040. doi: 10.1161/ATVBAHA.113.301627.Borissoff JI, Joosen IA, Versteylen MO et al. Elevated levels of circulating DNA and chromatin are independently associated with severe coronary atherosclerosis and a prothrombotic state. Arterioscler Thromb Vasc Biol. 2013;33(8):2032-2040. doi: 10.1161/ATVBAHA.113.301627.Castellheim A, Brekke OL, Espevik Tet al. Innate immune responses to danger signals in systemic inflammatory response syndrome and sepsis. Scand J Immunol. 2009;69(6):479-91. doi: 10.1111/j.1365-3083.2009.02255.x.Castellheim A, Brekke OL, Espevik Tet al. Innate immune responses to danger signals in systemic inflammatory response syndrome and sepsis. Scand J Immunol. 2009;69(6):479-91. doi: 10.1111/j.1365-3083.2009.02255.x.Gogenur M, Burcharth S, Gogenur J. The role of total cell-free DNA in predicting outcomes among trauma patients in the intensive care unit: a systematice review. Critical Care. 2017;21:14. doi: 10.1186/s13054-016-1578-9.Gogenur M, Burcharth S, Gogenur J. The role of total cell-free DNA in predicting outcomes among trauma patients in the intensive care unit: a systematice review. Critical Care. 2017;21:14. doi: 10.1186/s13054-016-1578-9.Hauser CJ, Sursal T, Rodriguez EK et al. Mitochondrial damage associated molecular patterns from femoral reamings activate neutrophils through formyl peptide receptors and P44/42MAP kinase. J Orthop Trauma. 2010;24(9):534-8. doi: 10.1097/BOT.0b013e3181ec4991.Hauser CJ, Sursal T, Rodriguez EK et al. Mitochondrial damage associated molecular patterns from femoral reamings activate neutrophils through formyl peptide receptors and P44/42MAP kinase. J Orthop Trauma. 2010;24(9):534-8. doi: 10.1097/BOT.0b013e3181ec4991.Likhvantsev VV, Landoni G, Grebenchikov OA et al. Nuclear DNA as Predictor of Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Graft: A Pilot Study. JCVA. 2017;31:2080-2085. doi: 10.1053/j.jvca.2017.04.051.Likhvantsev VV, Landoni G, Grebenchikov OA et al. Nuclear DNA as Predictor of Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Graft: A Pilot Study. JCVA. 2017;31:2080-2085. doi: 10.1053/j.jvca.2017.04.051.Lo YM., Rainer TH., Chan LY. et al. Plasma DNA as a prognostic marker in trauma patients. Clin Chem. 2000;46(3):319-23. PubMed PMID: 10702517.Lo YM., Rainer TH., Chan LY. et al. Plasma DNA as a prognostic marker in trauma patients. Clin Chem. 2000;46(3):319-23. PubMed PMID: 10702517.Tsai NW, Lin TK, Chen SD et al. The value of serial plasma nuclear and mitochondrial DNA levels in patients with acute ischemic stroke. Clin Chim Acta. 2011;412:476-479. doi: 10.1016/j.cca.2010.11.036.Tsai NW, Lin TK, Chen SD et al. The value of serial plasma nuclear and mitochondrial DNA levels in patients with acute ischemic stroke. Clin Chim Acta. 2011;412:476-479. doi: 10.1016/j.cca.2010.11.036.Vaara ST., Lakkisto P, Immonen K et al. Urinary biomarkers indicative of apoptosis and acute kidney injury in the critically ill. PLoS One. 2016;11:e0149956. doi: 10.1371/journal.pone.0149956.Vaara ST., Lakkisto P, Immonen K et al. Urinary biomarkers indicative of apoptosis and acute kidney injury in the critically ill. PLoS One. 2016;11:e0149956. doi: 10.1371/journal.pone.0149956.Zhang Q, Raoof M, Chen Y et al. Circulating mitochondrial DAMPs cause inflammatory responses to injury. Nature. 2010;464(7285):104-107. doi: 10.1038/nature08780.Zhang Q, Raoof M, Chen Y et al. Circulating mitochondrial DAMPs cause inflammatory responses to injury. Nature. 2010;464(7285):104-107. doi: 10.1038/nature08780.

The authors declare that there are no conflicts of interest present.