transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologiststransplantologiya-96Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONДинамика концентрации нитрита/нитрата и метгемоглобина в крови больных после трансплантации легких на фоне применения ингаляционного оксида азотаDynamic changes in blood concentrations of nitrite/nitrate and methemoglobin in patients after lung transplantation during treatment with inhaled nitric oxideХубутияМ. Ш.KhubutiyaM. Sh.КлычниковаЕ. В.KlychnikovaE. V.ТазинаЕ. В.TazinaE. V.tazina@yandex.ruТарабринЕ. А.TarabrinT. A.ПерваковаЭ. И.PervakovaE. I.РомановА. А.RomanovA. A.КуриловаО. А.KurilovaO. A.ГодковМ. А.GodkovM. A.ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ», МоскваРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department, MoscowRussian Federation20140502201604611Copyright © Хубутия М.Ш., Клычникова Е.В., Тазина Е.В., Тарабрин Е.А., Первакова Э.И., Романов А.А., Курилова О.А., Годков М.А., 20162016Хубутия М.Ш., Клычникова Е.В., Тазина Е.В., Тарабрин Е.А., Первакова Э.И., Романов А.А., Курилова О.А., Годков М.А.Khubutiya M.S., Klychnikova E.V., Tazina E.V., Tarabrin T.A., Pervakova E.I., Romanov A.A., Kurilova O.A., Godkov M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/96

Открытие роли оксида азота (NO) в патогенезе острых и хронических расстройств легочного кровообращения способствовало внедрению ингаляционного NO (иNO) в комплексную терапию больных после трансплантации легких (ТЛ). В организме иNO может  образовывать метгемоглобин (MetHb) и нитрат.

Цель исследования

Цель исследования: изучение взаимосвязи иNO, уровня  нитритов/нитратов (NOx) и MetHb в сыворотке крови 7 больных после ТЛ.

Продолжительность иNO-терапии составила 3 ± 1 сутки, данные проанализированы с 1-х по 10-е сутки после операции. У больных обнаружено статистически значимое повышение уровня NOx с 1-х по 5-е сутки после операции, концентрация MetHb при этом оставалась в пределах нормы. Выявлены статистически значимые положительные корреляции: между фактом применения иNO и концентрацией NOх, фактом применения иNO и концентрацией MetHb, концентрациями NOx и MetHb. Полученные данные свидетельствуют о том, что при использовании иNO у больных после ТЛ необходимо контролировать как концентрацию вводимого иNO и MetHb в крови, так и уровень NOx.

 

 

Understanding of the nitric oxide (NO) role in the pathogenesis of acute and chronic disorders of the pulmonary circulation contributed to the introduction of inhaled NO (iNO) in the complex therapy of patients after lung transplantation. Inhaled NO can form methemoglobin (MetHb) and nitrate. The aim of the study was to investigate the relationship between iNO and nitrite/nitrate (NOx) and MetHb levels in the blood serum of 7 patients after lung transplantation. Duration of iNO therapy was 3±1 days, the data were reviewed at 1 to 10 days after  transplantation. Patients showed significant improvement of the NOx level from day 1 to 5 after surgery, meanwhile the MetHb concentration remained within the normal range. The significant positive correlations were found between iNO and NOx concentrations, between iNO and MetHb concentrations, and between NOx and MetHb concentrations. The obtained results suggest that when using iNO in patients in lung transplantation, the concentration of the administered iNO, as well as blood levels of MetHb and NOx must be closely monitored.

 

трансплантация легкихингаляционный оксид азотанитрит/нитратметгемоглобинlung transplantationinhaled nitric oxidenitrite/nitratemethemoglobinReferencesMcQuitty C.K. Con: Inhaled nitric oxide should not be used routinely in patients undergoing lung transplantation. J. Cardiothorac. Vasc. Anesth. 2001; 15, (6): 790–792.McQuitty C.K. Con: Inhaled nitric oxide should not be used routinely in patients undergoing lung transplantation. J. Cardiothorac. Vasc. Anesth. 2001; 15, (6): 790–792.Marczin N. The biology of exhaled nitric oxide (NO) in ischemia-reperfusion-induced lung injury: a tale of dynamism of NO production and consumption. Vascul. Pharmacol. 2005; 43 (6): 415–424.Marczin N. The biology of exhaled nitric oxide (NO) in ischemia-reperfusion-induced lung injury: a tale of dynamism of NO production and consumption. Vascul. Pharmacol. 2005; 43 (6): 415–424.Yamashita H., Akamine S., Sumida Y., [et al.]. Inhaled nitric oxide attenuates apoptosis in ischemia-reperfusion injury of the rabbit lung. Ann. Thorac. Surg. 2004; 78 (1): 92–297.Yamashita H., Akamine S., Sumida Y., [et al.]. Inhaled nitric oxide attenuates apoptosis in ischemia-reperfusion injury of the rabbit lung. Ann. Thorac. Surg. 2004; 78 (1): 92–297.Rossaint R., Falke K.J., Lopez F., [et al.]. Inhaled nitric oxide for the adult respiratory distress syndrome. N. Engl. J. Med. 1993; 328 (6): 399–405.Rossaint R., Falke K.J., Lopez F., [et al.]. Inhaled nitric oxide for the adult respiratory distress syndrome. N. Engl. J. Med. 1993; 328 (6): 399–405.Della Rocca G., Pugliese F., Antonini M., [et al.]. Hemodynamics during inhaled nitric oxide in lung transplant candidates. Transplant Proc. 1997; 29 (8): 3367–3370.Della Rocca G., Pugliese F., Antonini M., [et al.]. Hemodynamics during inhaled nitric oxide in lung transplant candidates. Transplant Proc. 1997; 29 (8): 3367–3370.Rocca G.D., Coccia C., Pugliese F., [et al.]. Intraoperative inhaled nitric oxide during anesthesia for lung transplant. Transplant Proc. 1997; 29 (8): 3362–3366.Rocca G.D., Coccia C., Pugliese F., [et al.]. Intraoperative inhaled nitric oxide during anesthesia for lung transplant. Transplant Proc. 1997; 29 (8): 3362–3366.Meyer K.C., Love R.B., Zimmerman J.J. The therapeutic potential of nitric oxide in lung transplantation. Chest. 1998; 113 (5): 1360–1371.Meyer K.C., Love R.B., Zimmerman J.J. The therapeutic potential of nitric oxide in lung transplantation. Chest. 1998; 113 (5): 1360–1371.Ichinose F., Roberts Jr. J.D., Zapol W.M. Inhaled nitric oxide: a selective pulmonary vasodilator: current uses and therapeutic potential. Circulation. 2004; 109 (25): 3106–3111.Ichinose F., Roberts Jr. J.D., Zapol W.M. Inhaled nitric oxide: a selective pulmonary vasodilator: current uses and therapeutic potential. Circulation. 2004; 109 (25): 3106–3111.Young J.D., Sear J.W., Valvini E.M. Kinetics of methaemoglobin and serum nitrogen oxide production dur-ing inhalation of nitric oxide in volunteers. Br. J. Anaesth. 1996; 76 (5): 652–656.Young J.D., Sear J.W., Valvini E.M. Kinetics of methaemoglobin and serum nitrogen oxide production dur-ing inhalation of nitric oxide in volunteers. Br. J. Anaesth. 1996; 76 (5): 652–656.Weinberger B., Laskin D.L., Heck D.E., Laskin J.D. The toxicology of inhaled nitric oxide. Toxicol. Sci. 2001; 59 (1): 5–16.Weinberger B., Laskin D.L., Heck D.E., Laskin J.D. The toxicology of inhaled nitric oxide. Toxicol. Sci. 2001; 59 (1): 5–16.Golikov P.P., Nikolaeva N.Yu. Metod opredelenija nitrita/nitrata (NOx) v syvorotke krovi [Method for determination of nitrite/nitrate (NOx) in serum]. Biomed. himiya. 2004; 1: 79–85. (In Russian).Golikov P.P., Nikolaeva N.Yu. Metod opredelenija nitrita/nitrata (NOx) v syvorotke krovi [Method for determination of nitrite/nitrate (NOx) in serum]. Biomed. himiya. 2004; 1: 79–85. (In Russian).Steudel W., Hurford W.E., Zapol W.M. Inhaled nitric oxide: basic biology and clinical applications. Anesthesiology. 1999; 91 (4): 1090–1121.Steudel W., Hurford W.E., Zapol W.M. Inhaled nitric oxide: basic biology and clinical applications. Anesthesiology. 1999; 91 (4): 1090–1121.De Andrade J.A., Crow J.P., Viera L., [et al.]. Protein nitration, metabolites of reactive nitrogen species, and inflammationDe Andrade J.A., Crow J.P., Viera L., [et al.]. Protein nitration, metabolites of reactive nitrogen species, and inflammationin lung allografts. Crit. Care Med. 2000; 161 (6): 2035–2042.in lung allografts. Crit. Care Med. 2000; 161 (6): 2035–2042.De Andrade J.A., Crow J., Viera L., [et al.]. Reactive nitrogen species, airway inflammation, and fibrosis in lung transplant. Chest. 2001; 120 (1): S58–S59.De Andrade J.A., Crow J., Viera L., [et al.]. Reactive nitrogen species, airway inflammation, and fibrosis in lung transplant. Chest. 2001; 120 (1): S58–S59.Reid D., Snell G., Ward C., [et al.]. Iron overload and nitric oxide-derived oxidative stress following lung transplantation. J. Heart Lung Transplant. 2001; 20 (8): 840–849.Reid D., Snell G., Ward C., [et al.]. Iron overload and nitric oxide-derived oxidative stress following lung transplantation. J. Heart Lung Transplant. 2001; 20 (8): 840–849.Wiklund L., Lewis D.H., Sjöquist P.O., [et al.]. Increased levels of circulating nitrates and impaired endotheliummediated vasodila-tion suggest multiple roles of nitric oxide during acute rejection of pulmonary allografts. J. Heart Lung Transplant. 1997; 16 (5): 517–523.Wiklund L., Lewis D.H., Sjöquist P.O., [et al.]. Increased levels of circulating nitrates and impaired endotheliummediated vasodila-tion suggest multiple roles of nitric oxide during acute rejection of pulmonary allografts. J. Heart Lung Transplant. 1997; 16 (5): 517–523.Worrall N.K., Boasquevisque C.H., Misko T.P., [et al.]. Inducible nitric oxide synthase is expressed during experimental acute lung allograft rejection. J. Heart Lung Transplant. 1997; 16 (3): 334–339.Worrall N.K., Boasquevisque C.H., Misko T.P., [et al.]. Inducible nitric oxide synthase is expressed during experimental acute lung allograft rejection. J. Heart Lung Transplant. 1997; 16 (3): 334–339.

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