日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 38(1): 29-37 (2022)
doi:10.9794/jspccs.38.29

原著Original

人工心肺を用いた小児心臓周術期における遊離カルニチン濃度の検討Free Carnitine Levels during Cardiac Peri-Operative Periods with Cardiopulmonary Bypass in Pediatric Patients with Congenital Heart Diseases

1島根大学医学部小児科Department of Pediatrics, Shimane University Faculty of Medicine ◇ Shimane, Japan

2島根大学医学部心臓血管外科Department of Cardiovascular Surgery, Shimane University Faculty of Medicine ◇ Shimane, Japan

受付日:2021年11月16日Received: November 16, 2021
受理日:2022年1月18日Accepted: January 18, 2022
発行日:2022年2月1日Published: February 1, 2022
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目的:カルニチンはミトコンドリアにおけるエネルギー産生に必須の物質で,その欠乏により心筋症や低血糖などを生じる.本研究では,小児先天性心疾患患者の人工心肺(CPB)前後における血中遊離カルニチン(C0)値の動態を明らかにすることを目的とした.

方法:小児先天性心疾患児のCPB使用直前,直後,以後連日7日後までのC0値を測定した.

結果:対象は50例で,平均月齢は35±49か月であった.19例に心外合併症(染色体異常,早産児,消化器疾患等)を認めた.C0値は術前55.8±24.4 nmol/mLで,CPB直後に33.5±12.9 nmol/mL (p<0.01)と低下した.術翌日には96.3±42.1 nmol/mL (p<0.01)と上昇し,術後3日目には手術前と同程度に戻った.心外合併症の有無は周術期におけるC0低下と関連した(OR 3.385; 95%信頼区間1.858–3.385, p<0.01).

結語:C0値はCPB使用により術直後は一過性に低下するが術後3日目には戻った.臨床的にカルニチン補充を要する症例は認めなかったが,心外合併症例では周術期のカルニチンを測定することが必要かもしれない.

Objective: Carnitine is essential for long-chain fatty acid metabolism in order to produce biological energy via the mitochondria. Carnitine deficiency can result in cardiomyopathy, hypoglycemia, and other complications. This study aimed to determine how plasma carnitine levels changed before and after open-heart surgery with cardiopulmonary bypass (CPB) in children with congenital heart disease.

Methods: We measured free carnitine (C0) levels in the blood before and after CPB, as well as on each day 7 days after the procedure.

Results: We treated 50 patients with average age of 35±49 months. We identified 19 patients with extracardiac complications, including eight with chromosomal disorder, three with suspected chromosomal disorder, four preterm births, two with digestive disorders, and two with other complications. C0 levels immediately before CPB were 55.8±24.4 nmol/mL, whereas immediately after CPB were significantly lower [33.5±12.9 nmol/mL (the ratio of C0 level before and after CPB were: 64±19%, p<0.01)]. Although there was no significant difference in aortic clamp time, CPB time, or pre-operative blood data, the presence of extracardiac complications was significantly correlated to the C0 level just after CPB (odds ratio, OR: 3.385, 95% confidence interval, CI: 1.858–3.385, p<0.01).

Conclusion: C0 dropped temporarily after CPB and then returned three days later. Since the decrease in C0 after CPB was linked to extracardiac complications in children with congenital heart disease, monitoring pre- and post-operative C0 concentration may be warranted in these patients.

Key words: free carnitine; acylcarnitine; carnitine deficiency; cardiopulmonary bypass; congenital heart disease

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This page was last modified on 2022-05-25T19:36:55.000+09:00


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