Tennenberg S D, Bailey W W, Cotta L A, Brodt J K, Solomkin J S
Surgery. 1986 Aug;100(2):134-42.
Complement-mediated neutrophil activation (CMNA) has been implicated as an important pathophysiologic mechanism contributing to acute microvascular lung injury in the adult respiratory distress syndrome (ARDS). Using cardiopulmonary bypass (CPB) as a clinical model for complement-mediated microvascular injury, we studied the effects of methylprednisolone (MPSS) pretreatment on manifestations of CMNA in 28 pediatric patients undergoing CPB. Six patients not receiving MPSS served as controls. Results demonstrated that MPSS did not prevent complement activation as noted by 4.5- and 7.7-fold increases in plasma C3a des Arg levels during and immediately after CPB, respectively. However, detectable in vivo and in vitro manifestations of CMNA were altered. Neutropenia during CPB was attenuated to 65% of prebypass values compared with 47% in the control group. Neutrophil selective chemotactic desensitization toward C5a/C5a des Arg during the on bypass and postbypass periods was evident in the control group (0.41 and 0.76 cm specific migration, respectively) and prevented in the MPSS group (1.55 and 2.00 cm specific migration, respectively). We conclude that CMNA during CPB is ameliorated and/or prevented by MPSS pretreatment. These findings suggest that MPSS pretreatment may ameliorate complement-mediated microvascular (lung) injury in CPB and ARDS.
补体介导的中性粒细胞激活（CMNA）被认为是导致成人呼吸窘迫综合征（ARDS）急性微血管肺损伤的重要病理生理机制。我们以体外循环（CPB）作为补体介导的微血管损伤的临床模型，研究了甲泼尼龙（MPSS）预处理对28例接受CPB的儿科患者CMNA表现的影响。6例未接受MPSS的患者作为对照。结果表明，MPSS并不能阻止补体激活，CPB期间及CPB后即刻血浆C3a去精氨酸水平分别升高4.5倍和7.7倍即表明了这一点。然而，CMNA在体内和体外的可检测表现发生了改变。CPB期间的中性粒细胞减少症减轻至体外循环前值的65%，而对照组为47%。在对照组中，CPB期间和CPB后期间中性粒细胞对C5a/C5a去精氨酸的选择性趋化脱敏明显（特异性迁移分别为0.41和0.76 cm），而在MPSS组中则被阻止（特异性迁移分别为1.55和2.00 cm）。我们得出结论，MPSS预处理可改善和/或预防CPB期间的CMNA。这些发现表明，MPSS预处理可能改善CPB和ARDS中补体介导的微血管（肺）损伤。
