Al-Ruzzeh Sharif, Hoare Ginette, Marczin Nandor, Asimakopoulos George, George Shane, Taylor Kenneth, Amrani Mohamed
National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Harefield Hospital, Middlesex, United Kingdom.
Heart Surg Forum. 2003;6(2):89-93. doi: 10.1532/hsf.1205.
Coronary artery bypass grafting (CABG) surgery is associated with systemic inflammation. Activation of neutrophils is a crucial step in inflammation and results in neutrophil sequestration within the tissues. One of the potential advantages of performing off-pump coronary artery bypass (OPCAB) surgery is the attenuation of the systemic inflammatory response. This prospective randomized study compares neutrophil activation in patients undergoing OPCAB versus those undergoing CABG with cardiopulmonary bypass (CPB).
Twenty patients undergoing primary isolated CABG were randomly divided prospectively into 2 groups: 1 group underwent CABG with CPB, and the other group underwent OPCAB. Central venous blood samples were obtained before skin incision and at 15 minutes, 60 minutes, 2 hours, 5 hours, and 24 hours following the initiation of CPB or application of the stabilization device. Differential white cell counts were measured with routine laboratory techniques. CD11b surface expression on neutrophils was measured by flow cytometry. Interleukin 8 levels in the plasma were measured by enzyme-linked immunosorbent assays.
The 2 groups were matched with respect to preoperative and operative characteristics. White cell and neutrophil counts rose in both groups following the operation but were significantly higher in the OPCAB group at 5 hours (P < .001 and P = .002, respectively). Interleukin 8 concentrations were significantly higher in the CPB group at 5 hours following the initiation of CPB (P = .034). CD11b levels were significantly higher in the CPB group at 60 minutes (P = .002).
This prospective randomized study demonstrates that the activation of circulating neutrophils as measured by CD11b expression is lower following OPCAB than in CPB. Although OPCAB is associated with significantly higher neutrophil counts, these neutrophils exhibit fewer activation markers. The lower postoperative neutrophil counts occurring in the CPB group may be explained by the activation and consequent sequestration of the neutrophils in the CPB circuit and tissues.
冠状动脉旁路移植术（CABG）与全身炎症反应有关。中性粒细胞的激活是炎症反应中的关键步骤，会导致中性粒细胞在组织中滞留。非体外循环冠状动脉旁路移植术（OPCAB）的一个潜在优势是减轻全身炎症反应。这项前瞻性随机研究比较了接受OPCAB手术的患者与接受体外循环（CPB）冠状动脉旁路移植术患者的中性粒细胞激活情况。
20例行初次单纯CABG的患者被前瞻性随机分为2组：一组接受CPB下的CABG，另一组接受OPCAB。在皮肤切开前以及CPB开始或应用稳定装置后的15分钟、60分钟、2小时、5小时和24小时采集中心静脉血样本。用常规实验室技术测量白细胞分类计数。通过流式细胞术测量中性粒细胞表面CD11b的表达。采用酶联免疫吸附测定法测量血浆中白细胞介素8的水平。
两组在术前和手术特征方面相匹配。两组术后白细胞和中性粒细胞计数均升高，但OPCAB组在术后5小时显著更高（分别为P <.001和P =.002）。CPB开始后5小时，CPB组白细胞介素8浓度显著更高（P =.034）。CPB组在60分钟时CD11b水平显著更高（P =.002）。
这项前瞻性随机研究表明，通过CD11b表达测量，OPCAB术后循环中性粒细胞的激活低于CPB。虽然OPCAB术后中性粒细胞计数显著更高，但这些中性粒细胞表现出较少的激活标志物。CPB组术后中性粒细胞计数较低可能是由于CPB回路和组织中中性粒细胞的激活及随后的滞留所致。
