Alonso A, Whitten C W, Hill G E
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-4455, USA.
Ann Thorac Surg. 1999 Feb;67(2):392-5. doi: 10.1016/s0003-4975(98)01132-1.
The expression of neutrophil integrin CD11b is up-regulated after cardiopulmonary bypass (CPB) and is the neutrophil adhesive molecule of most importance in neutrophil- endothelial adherence. This neutrophil-endothelial adherence is responsible for post-CPB neutrophil-induced reperfusion injury. Low-dose aprotinin protocols inhibit the CPB-induced neutrophil CD11b up-regulation. This investigation was undertaken to evaluate the effects of pump prime only aprotinin (280 mg) on the CPB-induced up-regulation of this neutrophil integrin.
Twenty-two patients scheduled for elective myocardial revascularization were randomized into two groups: (1) control (n = 12), or (2) pump prime only aprotinin (280 mg) (n = 10). Neutrophils were isolated at baseline, 50 minutes of CPB, and 30 minutes after CPB and neutrophil CD11b expression was measured.
The control group demonstrated a significant (p < 0.05) increase in neutrophil CD11b immunofluorescent staining at 50 minutes of CPB and at 30 minutes after CPB when compared to same group baseline and to the pump prime only aprotinin group at similar time intervals.
These results indicate that pump prime only aprotinin modulates the CPB-induced up-regulation of neutrophil CD11b integrin, an important indicator of the systemic inflammatory response to CPB. In addition to blunting of the CPB-induced up-regulation of this neutrophil integrin expression, this pump prime only dose of aprotinin is also reported to be effective at reducing post-CPB bleeding and transfusion requirements. This salutary effect of pump prime only aprotinin suggests that such low-dose regimens can be both therapeutically effective and cost effective.
体外循环（CPB）后中性粒细胞整合素CD11b的表达上调，且是中性粒细胞与内皮细胞黏附中最重要的中性粒细胞黏附分子。这种中性粒细胞与内皮细胞的黏附是CPB后中性粒细胞诱导的再灌注损伤的原因。低剂量抑肽酶方案可抑制CPB诱导的中性粒细胞CD11b上调。本研究旨在评估仅在预充液中加入抑肽酶（280mg）对CPB诱导的这种中性粒细胞整合素上调的影响。
将22例计划进行择期心肌血运重建的患者随机分为两组：（1）对照组（n = 12），或（2）仅在预充液中加入抑肽酶（280mg）组（n = 10）。在基线、CPB50分钟时以及CPB后30分钟分离中性粒细胞，并检测中性粒细胞CD11b的表达。
与同组基线以及在相似时间间隔的仅在预充液中加入抑肽酶组相比，对照组在CPB50分钟时和CPB后30分钟时中性粒细胞CD11b免疫荧光染色显著增加（p < 0.05）。
这些结果表明，仅在预充液中加入抑肽酶可调节CPB诱导的中性粒细胞CD11b整合素上调，这是对CPB全身炎症反应的一个重要指标。除了减弱CPB诱导的这种中性粒细胞整合素表达上调外，据报道这种仅在预充液中加入的抑肽酶剂量在减少CPB后出血和输血需求方面也有效。仅在预充液中加入抑肽酶的这种有益作用表明，这种低剂量方案在治疗上既有效又具有成本效益。
