De Mol Van Otterloo J C, Van Bockel J H, Ponfoort E D, Brommer E J, Hermans J, Daha M R
Department of Surgery, University Hospital Leiden, The Netherlands.
J Vasc Surg. 1992 Nov;16(5):774-83.
Complement activation has been associated with numerous clinical hazards such as platelet aggregation, adult respiratory distress syndrome, and renal dysfunction. The complement system is activated by exposure of different biomaterials to blood. Recently a watertight knitted Dacron aortic prosthesis impregnated with bovine collagen has been developed. One potential disadvantage is that this bovine collagen may activate the complement system and evoke the production of inflammatory mediators. We conducted a prospective randomized trial to study the systemic effects of collagen-impregnated prostheses and of aortic surgery with implantation of Dacron prosthesis on the complement system in the perioperative period and at 3 months after operation. Forty-one patients randomly received either a collagen-impregnated (n = 20) or a nonimpregnated prosthesis (n = 21). Twelve patients who had cholecystectomy served as controls. CH50 consumption and C3a generation were determined to study overall complement activation. Furthermore, C3a/C3 fractions were calculated. Finally, C4 and factor B consumption were determined to evaluate the complement stimulation via the classic and the alternative pathways, respectively. We found significant activation of the complement system during the operation in both the collagen group (CH50 consumption: 40%, p = 0.03; C4 consumption: 74%, p < 0.0001; factor B consumption: 73%, p < 0.0001; C3a/C3 fraction increase: 173%,p = 0.04), and the nonimpregnated group (CH50 consumption: 40%, p < 0.0001; C4 consumption: 71%, p < 0.0001; factor B consumption: 76%, p < 0.0001; C3a/C3 fraction increase: 165%, p = 0.025), with no statistically significant differences between the groups of prostheses. Activation was initiated via both the classic and the alternative pathway. This indicates aortic implantation significantly activates the complement system, but that collagen-impregnated prostheses do not stimulate the complement system any more than its nonsealed substrate. Comparing results in patients with vascular disease with controls, a significantly increased complement activation was observed in the vascular group (CH50 consumption: 40%, p < 0.0001; C4 consumption: 74%, p < 0.0001; factor B consumption: 75%, p < 0.0001; C3a/C3 fraction: 169%, p = 0.002), compared with the controls (CH50 consumption: 71%; C4 consumption: 104%; factor B consumption: 94%; C3a/C3 fraction: 119%, all p = NS), with statistical significant differences between the vascular group and cholecystectomies (CH50: p = 0.005; C4: p = 0.002; factor B: p < 0.0001, and C3a/C3 fraction: NS). This observation demonstrates that aortic surgery with the implantation of a Dacron prosthesis significantly activates the complement system.
补体激活与多种临床危害相关，如血小板聚集、成人呼吸窘迫综合征和肾功能障碍。补体系统可因不同生物材料接触血液而被激活。最近，一种浸渍了牛胶原蛋白的防水针织涤纶主动脉假体已被研发出来。一个潜在的缺点是这种牛胶原蛋白可能会激活补体系统并引发炎症介质的产生。我们进行了一项前瞻性随机试验，以研究浸渍胶原蛋白的假体以及植入涤纶假体的主动脉手术在围手术期及术后3个月对补体系统的全身影响。41例患者被随机分为接受浸渍胶原蛋白的假体组（n = 20）或未浸渍假体组（n = 21）。12例行胆囊切除术的患者作为对照。通过测定CH50消耗和C3a生成来研究补体的整体激活情况。此外，计算C3a/C3比值。最后，分别测定C4和B因子消耗，以评估通过经典途径和替代途径的补体刺激情况。我们发现，手术期间胶原蛋白组（CH50消耗：40%，p = 0.03；C4消耗：74%，p < 0.0001；B因子消耗：73%，p < 0.0001；C3a/C3比值增加：173%，p = 0.04）和未浸渍组（CH50消耗：40%，p < 0.0001；C4消耗：71%，p < 0.0001；B因子消耗：76%，p < 0.0001；C3a/C3比值增加：165%，p = 0.025）的补体系统均有显著激活，两组假体之间无统计学显著差异。激活通过经典途径和替代途径启动。这表明主动脉植入显著激活补体系统，但浸渍胶原蛋白的假体对补体系统的刺激并不比未密封的基质更大。将血管疾病患者的结果与对照组比较，血管组补体激活显著增加（CH50消耗：40%，p < 0.0001；C4消耗：74%，p < 0.0001；B因子消耗：75%，p < 0.0001；C3a/C3比值：169%，p = 0.002），而对照组（CH50消耗：71%；C4消耗：104%；B因子消耗：94%；C3a/C3比值：119%，所有p = 无统计学意义），血管组与胆囊切除组之间有统计学显著差异（CH50：p = 0.005；C4：p = 0.002；B因子：p < 0.0001，C3a/C3比值：无统计学意义）。这一观察结果表明，植入涤纶假体的主动脉手术显著激活补体系统。
