Clinical Study On The Increases Of Plasma Homocysteine In Initial Days After Coronary Artery Bypass Grafting

Objective To review the dynamic changes of HCY, CRP, copper, ceruloplasmin, ferrum, folate and vitamin-B12 levels in patients undergoing cornary artery bypass grafting with CPB and without CPB. To discuss the reason plasma HCY levels increased significantly after surgery. To confirme the change of plasma copper may be of intimate relevance with the alteration of HCY levels, and its possible mechanism was expounded initially.Methods Forty patients with coronary artery disease undergoing elective first-time CABG were selected for the study. Eligibility for surgery with CPB(n=20) was based upon the medical history and coronary angiogram, and others(n=20) underwent OPCAB. Exclusion criteria included patients with acute myocardial infarction, abnormal liver function, renal dysfunction and failure, hypothyroidism and inflammation, also included emergency operation and patients after PTCA. (1) Blood samples for determination of plasma CRP, copper, ceruloplasmin, ferrum, folate, vitamin-B12 and HCY levels were collected 1 day before operation, 1 day after operation, 3 days after operation, 5 days after operation, 7 days after operation, respectively. (2) Other plasma parameters including GOT, GPT, BUN, Cr, Glu, Plasma lipoprotein, CK levels and clinical characteristicssuch as average heart rate, average blood pressure were monographed before operation, 1 day after operation, 3days after operation, 5 days after operation, 7 days after operation, respectively. (3) Recording numbers of anastomosis sites, intraoperative anaesthetic drugs, preoperative and postoperative drugs, and diet status, etc.Results All surgical procedures were successful, patients'postoperative recovery were smoothly without any complications and infection. (1) There were significant decreases in plasma concentrations of homocysteine 1 day after surgery, but significant increases 6 days postoperation; Ceruloplasmin increased significantly 3 days after operation, accordingly copper increased obviously 4 days postoperation; There were not significant changes about folate levels after surgery compared with baseline levels; Significant decreases were observed 3 days after operation about ferrurn levels and vitamin-B12, after that they elevated slowly; There were obvious increases about CRP levels 3 days after surgery, which recovered to baseline levels gradually. (2) Other parameters such as GOT, GPT, BUN, Cr, and CK levels were significant higher than preoperation, and they decreased to baseline levels 5 days after operation. There were not obvious changes about Plasma lipoprotein levels and average heart rate, average blood pressure after surgery compared to preoperative levels.(3)The dietary intake of all patients was low-salt and low-fat. All drugs except flumamine patients used in preoperation and postoperation, during exreacorporeal circulation and anesthesia had not influence to HCY metabolism.Conclusions l)There were significant increases in plasmaconcentrations of HCY, copper and ceruloplasmin after operation compared to baseline levels, and without difference between two groups. 2)The reason to cause HCY had a obvious increases was the raises of plasm copper and ceruloplasmin after surgery. The significiant increase in plasm HCY and copper may contributed to atherosclerosis disease and thrombotic disease of grafts.