Salama A, Hugo F, Heinrich D, Höge R, Müller R, Kiefel V, Mueller-Eckhardt C, Bhakdi S
Department of Internal Medicine, University of Giessen, West Germany.
N Engl J Med. 1988 Feb 18;318(7):408-14. doi: 10.1056/NEJM198802183180704.
Hemolysis, leukopenia, a hemostatic deficit, and nonspecific systemic reactions collectively known as the postperfusion syndrome develop in patients who undergo cardiopulmonary bypass. We now report that terminal C5b-9 complement complexes are deposited on erythrocytes and polymorphonuclear neutrophilic leukocytes during cardiopulmonary bypass. Plasma samples taken from 48 unselected patients during and at the end of cardiopulmonary bypass contained raised levels of fluid-phase SC5b-9 complement complexes, indicating that the complement sequence had been activated to completion. Various degrees of overt intravascular hemolysis were observed in all the patients, and lysed erythrocyte membranes were recovered from the blood samples. Immunoassays performed with use of antibodies to C5b-9 neoantigens demonstrated the presence of C5b-9 on red-cell ghosts but not on intact erythrocytes. The appearance of ghosts carrying C5b-9 always coincided with hemolysis. Furthermore, granulocytes isolated from 20 patients during bypass were all found to carry C5b-9 complexes, whereas cells isolated before or 24 hours after surgery carried no C5b-9. The neoantigen-positive material present in detergent extracts of granulocytes sedimented in a broad peak (25 to 40 sedimentation coefficient [S]) in sucrose-density gradients, exactly as did pore-forming C5b-9 complexes. Deposition of C5b-9 on blood cells during cardiopulmonary bypass may be partly responsible for the hemolysis and may augment granulocyte activation by the stimulation of arachidonate metabolism in those cells.
在接受体外循环的患者中会出现溶血、白细胞减少、止血缺陷以及统称为灌注后综合征的非特异性全身反应。我们现在报告，在体外循环期间，终末C5b - 9补体复合物沉积在红细胞和多形核嗜中性白细胞上。在48例未经挑选的患者体外循环期间及结束时采集的血浆样本中，液相SC5b - 9补体复合物水平升高，表明补体序列已被激活至完成状态。在所有患者中均观察到不同程度的明显血管内溶血，并且从血样中回收了裂解的红细胞膜。使用针对C5b - 9新抗原的抗体进行的免疫测定表明，在红细胞影上存在C5b - 9，但完整红细胞上没有。携带C5b - 9的红细胞影的出现总是与溶血同时发生。此外，在体外循环期间从20例患者中分离出的粒细胞均被发现携带C5b - 9复合物，而在手术前或手术后24小时分离出的细胞则不携带C5b - 9。粒细胞去污剂提取物中存在的新抗原阳性物质在蔗糖密度梯度中以宽峰（沉降系数[S]为25至40）沉降，与成孔的C5b - 9复合物完全相同。体外循环期间C5b - 9在血细胞上的沉积可能部分导致溶血，并可能通过刺激这些细胞中的花生四烯酸代谢来增强粒细胞激活。
