Steinberg J B, Kapelanski D P, Olson J D, Weiler J M
Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics.
J Thorac Cardiovasc Surg. 1993 Dec;106(6):1008-16.
Patients undergoing cardiopulmonary bypass are known to develop whole body inflammation that often results in a characteristic syndrome early postoperatively. This phenomenon has been attributed to complement activation caused by exposure of blood to the foreign surfaces of the cardiopulmonary bypass circuit. It has been unknown if cytokines are involved. Plasma levels of complement activation products (C3a, C4a, C5a, and C5b-9), interleukins (IL-1 beta, IL-2, IL-4, and IL-6), and tumor necrosis factor-alpha were measured at multiple time points before, during, and after cardiopulmonary bypass in 29 patients. No significant increase over preinduction levels was seen in the cytokines except for IL-6, which was significantly increased during cardiopulmonary bypass (p < 0.001), reaching a maximum 3 hours after cardiopulmonary bypass. C3a, C4a, and C5b-9 levels were significantly elevated during cardiopulmonary bypass (p < 0.001), with maximum C5b-9 levels preceding the IL-6 elevation. Heparin coating of the cardiopulmonary bypass circuit was not demonstrated to have an effect on activation of complement or cytokine production. There was no statistically significant correlation among hemodynamic variables or pulmonary function and complement, interleukin, or tumor necrosis factor-alpha levels. These results confirm the presence of complement activation and demonstrate the production of IL-6 after the generation of C5b-9 in patients undergoing cardiopulmonary bypass. IL-6 may contribute to adverse systemic reactions associated with cardiopulmonary bypass.
已知接受体外循环的患者会发生全身炎症反应，这通常会在术后早期导致一种特征性综合征。这种现象被归因于血液暴露于体外循环回路的异物表面所引起的补体激活。目前尚不清楚细胞因子是否参与其中。在29例患者体外循环前、中、后的多个时间点，测量了补体激活产物（C3a、C4a、C5a和C5b-9）、白细胞介素（IL-1β、IL-2、IL-4和IL-6）以及肿瘤坏死因子-α的血浆水平。除IL-6外，细胞因子水平与诱导前相比无显著升高，IL-6在体外循环期间显著升高（p<0.001），在体外循环后3小时达到峰值。C3a、C4a和C5b-9水平在体外循环期间显著升高（p<0.001），C5b-9的最高水平先于IL-6升高。未证明体外循环回路的肝素涂层对补体激活或细胞因子产生有影响。血流动力学变量或肺功能与补体、白细胞介素或肿瘤坏死因子-α水平之间无统计学显著相关性。这些结果证实了补体激活的存在，并证明了接受体外循环的患者在C5b-9产生后会产生IL-6。IL-6可能导致与体外循环相关的不良全身反应。
