Hammerschmidt D E, Stroncek D F, Bowers T K, Lammi-Keefe C J, Kurth D M, Ozalins A, Nicoloff D M, Lillehei R C, Craddock P R, Jacob H S
J Thorac Cardiovasc Surg. 1981 Mar;81(3):370-7.
Complement activation and pulmonary leukostasis with neutropenia occur in hemodialysis and filtration leukapheresis, with attendant pulmonary dysfunction. Wondering whether similar phenomena might attend cardiopulmonary bypass (CPB), we studied 34 patients undergoing coronary artery bypass operations. As in the other extracorporeal circulation systems, neutropenia (mean 44.7% +/- 4.3% SEM of prebypass PMN count) occurred during the first half hour of bypass and then a rebound neutrophilia followed. CH50 and C3H50 fell 22% to 25% (p for CH50 less than 0.01) during bypass, but C3 conversion and C5a were not demonstrable in patient plasmas. Nonetheless, polymorphonuclear neutrophils (PMNs) harvested late in bypass showed low adherence to nylon and selective chemotactic and aggregative insensitivity to C5a--functional aberrations which are seen after exposure to activated complement. Furthermore, smaller infusions of activated complement into animals produced neutropenia than were required to achieve a detectable [C5a] in the plasma. We conclude that neutropenia during CPB probably results from complement activation below the threshold of detection; complement-stimulated PMNs deserve study as possible mediators of tissue injury occurring during CPB.
在血液透析和过滤性白细胞去除术中会出现补体激活、肺白细胞淤滞伴中性粒细胞减少，并伴有肺功能障碍。考虑到心肺转流术（CPB）中是否也会出现类似现象，我们对34例接受冠状动脉搭桥手术的患者进行了研究。与其他体外循环系统一样，在转流的前半小时出现中性粒细胞减少（转流前中性粒细胞计数的平均值为44.7%±4.3%标准误），随后出现中性粒细胞增多反弹。转流期间，CH50和C3H50下降了22%至25%（CH50的p值小于0.01），但在患者血浆中未检测到C3转化和C5a。尽管如此，在转流后期采集的多形核中性粒细胞（PMN）对尼龙的黏附性较低，对C5a的选择性趋化和聚集不敏感——这些功能异常在暴露于活化补体后可见。此外，向动物体内注入较少量的活化补体即可产生中性粒细胞减少，而要在血浆中检测到[C5a]则需要注入更多。我们得出结论，CPB期间的中性粒细胞减少可能是由于补体激活低于检测阈值所致；受补体刺激的PMN作为CPB期间可能发生的组织损伤介质值得研究。
