Faymonville M E, Pincemail J, Duchateau J, Paulus J M, Adam A, Deby-Dupont G, Deby C, Albert A, Larbuisson R, Limet R
Department of Anesthesiology, University of Liège, Belgium.
J Thorac Cardiovasc Surg. 1991 Aug;102(2):309-17.
To assess leukocyte activation during cardiopulmonary bypass, we measured white blood cell and neutrophil counts and lysosomal enzyme release, especially myeloperoxidase and elastase, throughout the operation and for 5 days postoperatively. A newly developed double antibody radioimmunoassay of myeloperoxidase and an enzyme-linked immunosorbent assay for detection of the polymorphonuclear elastase-alpha 1-proteinase inhibitor complex were used to determine their plasma levels in 15 patients undergoing elective aorta-coronary bypass grafting. Preoperatively white blood cell counts and plasmatic levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor were normal. Because no correlation has yet been established between levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor, the aim of this prospective study was to evaluate the use of these enzyme levels as markers for leukocyte activation in vivo. We addressed the clinical situation of cardiopulmonary bypass because it offered the possibility of monitoring the comparative evolution of blood levels of these enzymes in parallel to white blood cell counts through well-defined steps corresponding to known events. We document the advantages of myeloperoxidase blood levels over elastase measurement as reflecting more rapidly the in vivo activation of leukocytes. The time course kinetics of these three measurements were not parallel. White blood cell counts remained stable at the beginning of bypass, whereas myeloperoxidase levels increased sharply and continuously as soon as bypass was instituted until the end of bypass. Elastase levels also increased, but later than myeloperoxidase, beginning when the patients was rewarmed. High elastase plasma levels persisted later than myeloperoxidase after bypass, in parallel with white blood cell counts. It thus clearly appears that changes in myeloperoxidase levels more rapidly reflect the activation state of leukocytes induced by cardiopulmonary bypass and surgery, whereas peak levels of elastase were delayed and parallel to white blood cell counts. From this model, in which the evolution of leukocyte numbers could be followed in relation with known steps of stimulation, it appears that myeloperoxidase is a sensitive marker for monitoring in vivo activation of white blood cells.
为评估体外循环期间的白细胞活化情况，我们在整个手术过程及术后5天内，对白细胞和中性粒细胞计数以及溶酶体酶释放情况进行了测量，尤其检测了髓过氧化物酶和弹性蛋白酶。采用新开发的髓过氧化物酶双抗体放射免疫分析法以及用于检测多形核弹性蛋白酶-α1-蛋白酶抑制剂复合物的酶联免疫吸附测定法，测定了15例行择期主动脉-冠状动脉搭桥术患者的血浆水平。术前白细胞计数以及髓过氧化物酶和弹性蛋白酶-α1-蛋白酶抑制剂的血浆水平均正常。由于尚未确定髓过氧化物酶水平与弹性蛋白酶-α1-蛋白酶抑制剂水平之间的相关性，本前瞻性研究的目的是评估将这些酶水平用作体内白细胞活化标志物的用途。我们研究了体外循环的临床情况，因为它提供了通过与已知事件相对应的明确步骤，并行监测这些酶的血液水平与白细胞计数的比较变化情况的可能性。我们记录了髓过氧化物酶血液水平相较于弹性蛋白酶测量的优势，即能更快反映白细胞的体内活化情况。这三项测量的时间进程动力学并不平行。体外循环开始时白细胞计数保持稳定，而髓过氧化物酶水平在体外循环一开始就急剧且持续升高，直至体外循环结束。弹性蛋白酶水平也升高，但晚于髓过氧化物酶，在患者复温时开始升高。体外循环后，高弹性蛋白酶血浆水平比髓过氧化物酶持续的时间更长，与白细胞计数平行。因此，很明显髓过氧化物酶水平的变化能更快反映体外循环和手术诱导的白细胞活化状态，而弹性蛋白酶的峰值水平出现延迟且与白细胞计数平行。从这个能够追踪白细胞数量与已知刺激步骤相关变化的模型来看，髓过氧化物酶似乎是监测白细胞体内活化的敏感标志物。
