Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Ann Thorac Surg. 2010 Mar;89(3):710-6. doi: 10.1016/j.athoracsur.2009.11.049.
The complement system is a key component in the inflammatory response after coronary artery bypass grafting (CABG). The routes of complement activation and deactivation after cardiac surgery are not clear. The aim of this study was to analyze routes of complement activation after uncomplicated CABG.
Complement components and activation products were measured in 20 nondiabetic adult patients undergoing elective CABG at several times postoperatively starting at admission to the intensive care unit.
Complement activation after uncomplicated CABG showed a biphasic pattern. In the first 8 hours after admission to the intensive care unit, complement activation was initiated by the classical lectin pathway and augmented by the alternative pathway. Ultimately, this resulted in terminal pathway activation and formation of terminal complement complex. In the second phase, starting at 8 hours after the operation, complement was still activated by the classical lectin pathway, but there was no augmentation by the alternative pathway and no terminal complement complex formation. This implies that during this second stage, inhibitory mechanisms beyond C3b are engaged.
Complement activation after cardiac surgery is regulated in a complex biphasic way, with additional inhibitory mechanisms engaged from 8 hours postoperatively onward.
补体系统是冠状动脉旁路移植术（CABG）后炎症反应的关键组成部分。心脏手术后补体的激活和失活途径尚不清楚。本研究旨在分析非复杂性 CABG 后补体的激活途径。
在术后开始入住重症监护病房的几个时间点，测量 20 名非糖尿病成年患者在接受择期 CABG 时的补体成分和激活产物。
非复杂性 CABG 后的补体激活呈双相模式。在入住重症监护病房后的前 8 小时内，经典凝集素途径启动补体激活，并通过替代途径增强。最终，这导致末端途径激活和末端补体复合物的形成。在第二阶段，从手术后 8 小时开始，补体仍通过经典凝集素途径激活，但替代途径没有增强，也没有形成末端补体复合物。这意味着在第二阶段，补体结合蛋白（C3b）以外的抑制机制被激活。
心脏手术后补体的激活是通过一种复杂的双相方式调节的，从术后 8 小时开始，还会激活其他抑制机制。
