Chello M, Mastroroberto P, Malta E, Cirillo F, Celi V
Department of Experimental and Clinical Medicine, Medical School of Catanzaro, Italy.
Ann Thorac Surg. 1999 May;67(5):1277-82. doi: 10.1016/s0003-4975(99)00173-3.
Release of reactive oxygen radicals by activated neutrophils and neutrophil adhesion to endothelial cells have been observed after cardiopulmonary bypass. The aim of the present study was to evaluate the effects of preoperative dipyridamole treatment on neutrophil superoxide anion generation and endothelial cell-neutrophil interactions.
Two groups of patients scheduled for elective coronary artery bypass grafting were randomized to receive oral dipyridamole or a placebo. Nitro blue tetrazolium scores of circulating neutrophils, neutrophil CD11b/CD18 expression, and their adhesion to human umbilical vein endothelial cells were assayed before anesthesia, 30 minutes after the beginning of cardiopulmonary bypass, at the end of bypass, and 60 minutes postoperatively.
In both groups, cardiopulmonary bypass resulted in a significant increase in nitro blue tetrazolium scores in circulating neutrophils as well as a significant increase in both neutrophil CD11b/CD18 expression and neutrophil adhesion to endothelial cells. The extent of neutrophil superoxide anion generation was higher in the control group; a significant (p < 0.01) reduction in neutrophil adhesion to endothelial cells was observed 1 hour postoperatively in the dipyridamole group. In 5 patients treated with dipyridamole, the incubation of activated polymorphonuclear leukocytes with adenosine deaminase significantly increased their adhesion to endothelial cells (p < 0.05).
Our study demonstrated that preoperative treatment with oral dipyridamole significantly reduces both neutrophil superoxide anion generation and extent of neutrophil adhesion to endothelial cells after coronary bypass grafting procedures with cardiopulmonary bypass. The mechanism is probably mediated by endogenous adenosine.
体外循环后已观察到活化的中性粒细胞释放活性氧自由基以及中性粒细胞与内皮细胞的黏附。本研究的目的是评估术前双嘧达莫治疗对中性粒细胞超氧阴离子生成及内皮细胞 - 中性粒细胞相互作用的影响。
两组计划行择期冠状动脉旁路移植术的患者被随机分配接受口服双嘧达莫或安慰剂。在麻醉前、体外循环开始后30分钟、体外循环结束时及术后60分钟，测定循环中性粒细胞的硝基蓝四唑评分、中性粒细胞CD11b/CD18表达及其与人脐静脉内皮细胞的黏附情况。
两组中，体外循环均导致循环中性粒细胞的硝基蓝四唑评分显著增加，以及中性粒细胞CD11b/CD18表达和中性粒细胞与内皮细胞的黏附均显著增加。对照组中性粒细胞超氧阴离子生成的程度更高；双嘧达莫组术后1小时观察到中性粒细胞与内皮细胞的黏附显著（p < 0.01）降低。在5例接受双嘧达莫治疗的患者中，活化的多形核白细胞与腺苷脱氨酶孵育后，其与内皮细胞的黏附显著增加（p < 0.05）。
我们的研究表明，术前口服双嘧达莫治疗可显著降低冠状动脉旁路移植术体外循环后中性粒细胞超氧阴离子生成及中性粒细胞与内皮细胞的黏附程度。其机制可能由内源性腺苷介导。
