Tárnok A, Bocsi J, Rössler H, Schlykow V, Schneider P, Hambsch J
Pediatric Cardiology, Cardiac Center Leipzig, University of Leipzig, Germany.
Cytometry. 2001 Feb 15;46(1):41-9. doi: 10.1002/1097-0320(20010215)46:1<41::aid-cyto1036>3.0.co;2-u.
Enhanced expression of adhesion molecules LFA-1 (CD11a/CD18) and Mac-1 (CD11b/CD18) following cardiac surgery with cardiopulmonary bypass (CPB) is held responsible for postoperative complications. Surface expression of these molecules, intracellular pH (pH(i)), and oxidative burst capacity was analyzed to test for neutrophil activation during pediatric cardiac surgery.
Blood samples were drawn from 36 patients (age: 3--16 years) 24 h preoperatively, after onset of anesthesia, after connection to CPB (CPB1, before and after passing CPB, n = 15), at reperfusion (CPB2), and up to 7 days postoperatively. Cells adhering to CPB filters were isolated (n = 11). Antigen expression, pH(i), and oxidative burst capacity on neutrophils was analyzed by flow cytometry.
During surgery, oxidative burst capacity was at low level with a mild increase only 1 day after surgery. pH(i) was decreased throughout the surgery. Surgery induced more than 36% decrease of LFA-1 and Mac-1 expression (P < 0.03). Up to postoperative day 7, no increase of antigen expression above baseline was found. Neutrophils isolated from filters of the CPB had increased LFA-1 and Mac-1 expression (all P < 0.05). Integrin expression on neutrophils passing the CPB at CPB1 was decreased (P < 0.05).
Reduced adhesion molecule expression on neutrophils may be due to selective filtration of highly adhesive cells. This, in combination with low-level oxidative burst capacity, induced by immunosuppressive cytokines (e.g., interleukin-10), reduced the neutrophil activity. Our data indicate that increased activity of circulating neutrophils cannot exclusively be held responsible for postoperative complications after surgery with CPB.
体外循环（CPB）心脏手术后粘附分子LFA-1（CD11a/CD18）和Mac-1（CD11b/CD18）表达增强被认为是术后并发症的原因。分析这些分子的表面表达、细胞内pH值（pH(i)）和氧化爆发能力，以检测小儿心脏手术期间的中性粒细胞活化情况。
从36例患者（年龄：3 - 16岁）术前24小时、麻醉开始后、连接CPB后（CPB1，通过CPB前后，n = 15）、再灌注时（CPB2）以及术后长达7天采集血样。分离粘附在CPB滤器上的细胞（n = 11）。通过流式细胞术分析中性粒细胞上的抗原表达、pH(i)和氧化爆发能力。
手术期间，氧化爆发能力处于低水平，仅在术后1天有轻度增加。整个手术过程中pH(i)降低。手术导致LFA-1和Mac-1表达下降超过36%（P < 0.03）。直到术后第7天，未发现抗原表达高于基线水平的增加。从CPB滤器分离的中性粒细胞LFA-1和Mac-1表达增加（所有P < 0.05）。在CPB1时通过CPB的中性粒细胞上的整合素表达降低（P < 0.05）。
中性粒细胞上粘附分子表达降低可能是由于高粘附性细胞的选择性过滤。这与免疫抑制细胞因子（如白细胞介素-10）诱导的低水平氧化爆发能力相结合，降低了中性粒细胞活性。我们的数据表明，循环中性粒细胞活性增加不能完全归因于CPB心脏手术后的术后并发症。
