Onassis Cardiac Surgery Center, Athens, Greece.
J Clin Lab Anal. 2010;24(6):389-98. doi: 10.1002/jcla.20416.
Cardiopulmonary bypass (CPB) has been associated with activation and injury of endothelial cells, probably responsible for the systemic inflammatory response syndrome (SIRS) taking place in these patients.
We measured plasma concentrations of soluble P-selectin (sP-s), E-selectin (sE-s), tetranectin (TN), vonWillebrand factor (vWF) levels, and angiotensin-converting enzyme (ACE) activity in 31 adult patients undergoing elective coronary artery bypass grafting, just before and up to three days after surgery, and in 25 healthy volunteers.
Patients showed higher plasma sP-s and sE-s and ACE concentrations, just before surgery, but significantly lower TN levels, compared with controls. During the first three postoperative days (PD), the concentration of each of the molecules followed a different and independent pattern, although in the third PD, the levels of sP-s, sE-s and ACE were higher and those of vWF and TN lower, compared with the preoperative ones. However, patients had higher sP-s (P=0.06), sE-s (P=0.07), and vWF (P=0.005), but lower TN concentrations (P=0.02) on the third PD compared with controls.
CPB is characterised by pronounced changes in plasma sP-s, sE-s, TN, vWF levels, and ACE activity, which are associated with significant alteration in the intra- and early postoperative endothelial function observed in open heart surgery.
体外循环（CPB）可激活和损伤内皮细胞，这可能是发生于此类患者的全身炎症反应综合征（SIRS）的原因。
我们测量了 31 例行择期冠状动脉旁路移植术的成年患者及 25 名健康志愿者术前及术后 3 天的血浆可溶性 P 选择素（sP-s）、E 选择素（sE-s）、四旋蛋白（TN）、血管性血友病因子（vWF）水平和血管紧张素转换酶（ACE）活性。
患者术前的血浆 sP-s、sE-s 和 ACE 浓度较高，但 TN 水平明显较低。在术后的头 3 天（PD），尽管在第 3 天 PD，sP-s、sE-s 和 ACE 水平升高，vWF 和 TN 水平降低，但每种分子的浓度均呈现出不同且独立的模式，与术前相比。然而，与对照组相比，患者在第 3 天 PD 时具有更高的 sP-s（P=0.06）、sE-s（P=0.07）和 vWF（P=0.005），但更低的 TN 浓度（P=0.02）。
CPB 的特点是血浆 sP-s、sE-s、TN、vWF 水平和 ACE 活性发生明显变化，与心脏直视手术后观察到的内皮功能的显著改变有关。
