Cohen J R, Dietzek A, Tyras D, Graver L M, Wise L
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, N.Y.
J Cardiovasc Surg (Torino). 1989 Sep-Oct;30(5):817-20.
We have previously reported that aortic tissue elastase increases with operative trauma unrelated to direct aortic injury in rabbits and that increased tissue elastase may be responsible for abdominal aortic aneurysm (AAA) rupture in humans. In the current study we studied the levels of human neutrophil and serum proteolytic activity in response to elective surgical trauma. Serum elastase, neutrophil elastase and alpha-1-antitrypsin (A-1-AT) were determined in 20 patients undergoing elective coronary artery bypass grafting. Neutrophil proteolytic activity was significantly lower the day of surgery and on postoperative day 6 while serum proteolytic activity was significantly higher the day of surgery and on postoperative day 6 compared to preoperative values. If increased serum proteolytic activity increases the chance of rupture of an AAA, then the release of neutrophil elastase may provide a mechanism whereby asymptomatic AAAs rupture after unrelated elective surgery.
我们之前曾报道，在兔子身上，与直接主动脉损伤无关的手术创伤会导致主动脉组织弹性蛋白酶增加，而且组织弹性蛋白酶增加可能是人类腹主动脉瘤（AAA）破裂的原因。在当前研究中，我们研究了择期手术创伤后人类中性粒细胞和血清蛋白水解活性的水平。对20例行择期冠状动脉搭桥术的患者测定了血清弹性蛋白酶、中性粒细胞弹性蛋白酶和α-1-抗胰蛋白酶（A-1-AT）。与术前值相比，中性粒细胞蛋白水解活性在手术当天和术后第6天显著降低，而血清蛋白水解活性在手术当天和术后第6天显著升高。如果血清蛋白水解活性增加会增加AAA破裂的几率，那么中性粒细胞弹性蛋白酶的释放可能提供了一种机制，使得无症状AAA在无关的择期手术后破裂。
