The serum levels of IL-8, IL-10, and TNF-α, Cardiac troponin I (cTnI), Creatine kinase-MB (CK-MB) in Patients with Rheumatic Heart Disease Received Dexmedetomidine

serum levels of IL-8, IL-10, and TNF-α, Cardiac troponin I (cTnI), Creatine kinase-MB (CK-MB)

  • Caiyun Zhang 2Department of Cardiovascular Surgery, West China Hospital Of Sichuan University, Chengdu 610045, Sichuan Province, China
Keywords: serum levels of IL-8, IL-10, and TNF-α, Cardiac troponin I (cTnI), Creatine kinase-MB (CK-MB) ,DEX; RHD valve replacement; Inflammatory factors; CPB; Myocardial injury

Abstract


Introduction: It aimed to explore the application of dexmedetomidine (DEX) in rheumatic heart disease (RHD) valve replacement surgery and its effect on serum levels of IL-8, IL-10, and TNF-α, Cardiac troponin I (cTnI), Creatine kinase-MB (CK-MB).

Material and Method: 140 cardiopulmonary bypass (CPB) heart valve replacement patients in West China Hospital Of Sichuan University between January 2022 and December 2024 were randomly grouped: observation group and controls. The observed subjects were given DEX, and the controls was given normal saline. The amount of anesthetic, the myocardial injury markers, cellular immune function, inflammatory factors, and adverse reactions were observed.

Result: As against the controls, the observation group had visibly lower anesthetic dosage, higher heart rate (HR) at T5 and mean arterial pressure (MAP) at T2, T3, and T5, and lower myocardial injury markers (P < 0.05). There were similar in CD4+, CD8+, and CD4+/ CD8+ between subjects before surgery. As against the controls, CD4+ and CD4+/CD8+ were visibly higher, and CD8+was visibly lower in the observation group during and following operation (P < 0.05). There was similar in interleukin-8 (IL-8), IL-10, and tumor necrosis factor-α (TNF-α) before operation (P > 0.05). As against the controls, the postoperative IL-8 and TNF-α were visibly lower, and IL-10 was visibly higher in observed subjects (P < 0.05). There was similar in adverse reactions of the subjects (P >0.05).

Conclusion: DEX can reduce the dosage of anesthetics, maintain hemodynamic stability, reduce myocardial injury, and reduce the level of inflammatory factors.

References

1. Kumar RK, Antunes MJ, Beaton A, Mirabel M, Nkomo VT, Okello E, Regmi PR, Remenyi B, Sliwa-Hahnle K, ZuhlkeLJ, Sable C. Contemporary diagnosis and management of rheumatic heart disease: implications for closing the gap: a scientific statement from the American Heart Association. Circulation, 2020;142(20):e337-e357.
2. Marijon E, Mocumbi A, Narayanan K, Jouven X, Celermajer DS. Persisting burden and challenges of rheumatic heart disease. Eur Heart J, 2021;42(34):3338-3348.
3. Beaton A, Okello E, Rwebembera J, Grobler A, Engelman D, Alepere J, Canales L, Carapetis J, DeWyer A, Lwabi P, Mirabe M, Mocumbi AO, Murali M, Nakitto M, Ndagire E, Nunes MCP, Omara IO, Samacki R, Scheel A, Wilson N, Zimmerman M, Zuhlke L, Karthikeyan G, Sable CA, Steer AC. Secondary antibiotic prophylaxis for latent rheumatic heart disease. N Engl J Med; 2022;386(3):230-240.
4. Connolly SJ, Karthikeyan G, Ntsekhe M, Haileamlak A. Rivaroxaban in rheumatic heart disease–associated atrial fibrillation. N Engl J Med, 2022;387(22):2100-2101.
5. KatzenellenbogenJM, Bond‐Smith D, Seth RJ, DempseyK, Cannon J, Stacey I, Wade V, de Klerk N, Greenland M, Sanfilippo FM, Brown A, Carapetis JR, Wyber R, Nedkoff L, Hung J, Bessarab D, Ralph AP. Contemporary incidence and prevalence of rheumatic fever and rheumatic heart disease in Australia using linked data: the case for policy change. J Am Heart Assoc, 2020;9(19):e016851(1-26).
6. Muhamed B, Parks T, Sliwa K. Genetics of rheumatic fever and rheumatic heart disease. Nat Rev Cardiol, 2020;17(3):145-154.
7. Gong HY, Wang ZY, Sui YZ, Zhao JJ, Jing YY, Wang M. Effects of dexmedetomidine combined with propofol on peri-anesthesia hemodynamics and postoperative sedation and analgesia in patients undergoing radical esophagectomy. J Biol Regul Homeost Agents, 2020;34(6):2171-2175.
8. Lee S. Dexmedetomidine: present and future directions. Korean J Anesthesiol, 2019;72(4):323-330.
9. Zhao Y, He JS, Yu N, Jia CX, Wang SL. Mechanisms of dexmedetomidine in neuropathic pain. Front Neurosci, 2020;14:330(1-11).
10. Chen W, Wang Y, Pan ZG, Chen XY, Luo DH, Wang HY. Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery. Exp Ther Med, 2021;21(5):1-9.
11. Abdelrahman KA, Hassan SA, Mohammed AA, Abdelhakeem EE, Abd-Elshafy SK, Salama RH, Abdalla EM. The effect of dexmedetomidine on the inflammatory response in children undergoing repair of congenital heart disease: a randomized controlled clinical trial. Egypt J Anaesth, 2020;36(1):297-304.
12. Depuru A, Bhatia N, Bhagat H, Singh A. Awake Cranioplasty in a Patient with Rheumatic Heart Disease: A Novel Approach. J Neuroanaesthesiol Crit Care, 2022;9(03):183-185.
13. Cheng YT, Lee KT, Chang CH, Wu VCC, Chan YS, Chen DY, Chu PH, Chou AH, Liu KS, Chen SW. Effects of dexmedetomidine on surgery for type A acute aortic dissection outcome. Sci Rep, 2022;12(1):2761(1-7).
14. Wu HH, Tang JQ, Pan JM, Han M, Cai HJ, Zhang H. Effects of dexmedetomidine on stress hormones in patients undergoing cardiac valve replacement: a randomized controlled trial. BMC anesthesiol, 2020;20(1):142(1-9).
15. Chang JH, Jin MM, Liu JT. Dexmedetomidine pretreatment protects the heart against apoptosis in ischemia/reperfusion injury in diabetic rats by activating PI3K/Akt signaling in vivo and in vitro. Biomed Pharmacother, 2020,127:110188(1-10).
16. Huang LL, Qin CQ, Wang L, Zhang TJ, Li JG. Effects of dexmedetomidine on immune response in patients undergoing radical and reconstructive surgery for oral cancer. Oncol Lett, 2021;21(2):106(1-8).
17. Liu GC, Sun K, Fu HG, Dong TL , Yuan F. Effects of dexmedetomidine on injury of lungs and CHOP protein expression in elderly patients with lung cancer during one-lung ventilation. Zhonghua yi xue za zhi, 2020;100(1):37-41.
18. Xin X, Chen J, Hua W, Wang HY. Intraoperative dexmedetomidine for prevention of postoperative delirium in elderly patients with mild cognitive impairment. Int J Geriatr Psychiatr, 2021;36(1):143-151.
19. Carozza R, Fazzi D, Pietrini A, Cefarelli M, Mazzocca F, Vessella W, Berretta P, Romagnoli M, Alfonsi J, Zahedi HM, Munch C, Di Eusanio M. Minimally invasive aortic valve replacement: extracorporeal circulation optimization and minimally invasive extracorporeal circulation system evolution. Perfusion-UK, 2020;35(8):865-869.
20. Lovell S, Simon B, Boudreau EC, Mankin J, Jeffery N. Randomized clinical trial comparing outcomes after fentanyl or ketamine‐dexmedetomidine analgesia in thoracolumbar spinal surgery in dogs. J Vet Intern Med, 2022;36(5):1742-1751.
21. Zhai WQ, Yang LM, Sun P, Li YF, Han JG, Wang GL. Effect of dexmedetomidine on hemodynamic changes and inflammatory responses in patients undergoing off-pump coronary-artery bypass grafting. Exp Ther Med, 2020;20(6):250(1-7).
22. Cui C, Yu DN, Wang H, Kang Y, Long RC, Zhu Y, Ma J. Sedative effect of dexmedetomidine in induced abortion. Int J Clin Exp Med, 2019;12(10):12363-12369.
23. Tan C, Yan ST, Shen J, Wu H, Yu LY, Wang Y, Tian SP, Zhou W, Wu Y, Zhang ZA. Effects of dexmedetomidine on cardiac electrophysiology in patients undergoing general anesthesia during perioperative period: a randomized controlled trial. BMC anesthesiol, 2022;22(1):271(1-14).
24. Wang K, Wu MG, Xu J, Wu CS, Zhang BH, Wang GN, Ma DQ. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth, 2019;123(6):777-794.
25. Wen QP, Miao Z, Wu P, Wang J, Zhou FC, Lin Y, Lu XY, Lv R, Hou QH. Whole-course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia for patients with lung cancer undergoing thoracoscopic surgery: a randomized control trial. Pain Physician, 2020;23(2):E185-E193.
26. Chen R, Sun Y, Lv J, Dou XL, Dai MS, Sun SJ, Lin Y. Effects of dexmedetomidine on immune cells: a narrative review. Front Pharmacol, 2022;13:829951(1-12).
27. Ding MY, Chen Y, Luan HF, Zhang XB, Zhao ZB, Wu Y. Dexmedetomidine reduces inflammation in traumatic brain injury by regulating the inflammatory responses of macrophages and splenocytes. Exp Ther Med, 2019;18(3):2323-2331.
28. Golebski K, Layhadi JA, Sahiner U, Steveling-Klein EH, Lenormand MM, Li RCY, Bal SM, Heesters BA, Vila-Nadal G, Hunewald O, Montamat G, He FQ, Ollert M, Fedina O, Lao-Araya M, Vijverberg SJH, Maitland-van der Zee AH, van Drunen CM, Fokkens WJ, Durham SR, Spits H, Shamji MH. Induction of IL-10-producing type 2 innate lymphoid cells by allergen immunotherapy is associated with clinical response. Immunity, 2021;54(2):291-307.
29. Fang DF, Zhu JF. Molecular switches for regulating the differentiation of inflammatory and IL-10-producing anti-inflammatory T-helper cells. Cell Mol Life Sci, 2020;77(2):289-303.
30. Dong WT, Li X, Wang XK, Cheng X, Kong LD, Guo ZY, Jing H. Influence of Dexmedetomidine on Cognitive Function and Inflammatory Factors in Rats and Analysis of Its Molecular Mechanism after Cardiac Surgery under Cardiopulmonary Bypass. Cell Mol Biol, 2022;68(2):119-125.
Published
2025/03/20
Section
Original paper