[Leukocyte adhesion molecule expression and circulating ICAM-1, E-selectin levels during cardiopulmonary bypass in patients undergoing valve replacement].

The objectives of this study were to measure leukocyte adhesion molecule expression, assess the possibility of evaluating the serum levels of the soluble form of endothelium adhesion molecule as an alternative for endothelia cell activation, and analyze the correlation and regression between leukocyte adhesion molecule expression and soluble endothelium adhesion molecule levels during cardiopulmonary bypass (CPB) in patients undergoing valve replacement. Twelve adult patients were included in this study. The extracorporeal circuit was primed with Ringer's lactate. After systemic heparinization (300 IU/kg), CPB was initiated with a bubble oxygenator. Patients were cooled to about 28 degrees C, at that temperature, aorta was clamped and cold crystalloid cardioplegia was delivered into aortic root. The activatal clotting time was maintained at greater than 450 seconds. 1-1. 3 mg of protamine was administered for each 100 IU of heparin given prior to CPB. Peripheral blood was collected at the day prior to surgery and the morning of postoperative days 1, 2, 5, and 7 for determination of the expression of leukocyte CD11a, CD18, CD11a/CD18, CD11b, CD11b/CD18 (immunofluorescent flow cytometry) and the plasma soluble intercellular adhesion molecule-1(sICAM-1), soluble E-selectin (sE-selectin) (enzyme-linked immunoabsorbent assay). CPB caused a sustained increase in the leukocyte CD11a, CD18, CD11a/CD18, CD11b/CD18 expression and the plasma sICAM-1, sE-selectin levels in patients (P < 0.05). Upregulation of the leukocyte adhesion molecule expression and increase of the circulation endothelium adhesion molecule levels lasted at least 2 days after surgery (P < 0.05) except CD11a. There were correlation and regression between leukocyte adhesion molecule expression and soluble endothelium adhesion molecule levels (r = 0.91-0.99, P = 0.0322-0.0005; Y = -1377.06-44.64 + 1.49-14.78a to Y = 44.64 + 1.49a). These results suggest that CPB causes obvious leukocyte-endothelia interactions, that the expression of these adhesion molecules are presented by means of receptor-ligand form, and that the measurement of sICAM-1 and sE-selectin may well be used as a marker of endothelial cell activation.