te Velthuis H, Jansen P G, Hack C E, Eijsman L, Wildevuur C R
Centre for Cardiopulmonary Surgery Amsterdam, The Netherlands.
Ann Thorac Surg. 1996 Apr;61(4):1153-7. doi: 10.1016/0003-4975(95)01199-4.
Although it is well established that heparin-coated extracorporeal circuits reduce complement activation during cardiac operations, little in vivo information is available on the reduction in alternative and classic pathway activation.
In a prospective, randomized study involving patients undergoing coronary artery bypass grafting with standard full heparinization, we compared heparin-coated circuits (Duraflo II) (10 patients) with uncoated circuits (10 patients) and assessed the extent of initiation of complement activation by detecting iC3 (C3b-like C3) concentrations, classic pathway activation by C4b/c (C4b, iC4b, C4c) concentrations, terminal pathway activation by soluble C5b-9 concentrations, and C3 activation by C3a (C3a desArg) and C3b/c (C3b, iC3b, C3c) concentrations.
Heparin-coated extracorporeal circuits significantly reduced circulating complement activation product C3b/c and soluble C5b-9 concentrations at the end of cardiopulmonary bypass and after protamine sulfate administration compared with the uncoated circuits, but not iC3, C4b/c, or C3a concentrations.
Heparin-coated extracorporeal circuits reduce complement activation through the alternative complement pathway, probably at the C3 convertase level, and, consequently, the terminal pathway. C3b/c seems to be a more sensitive marker than C3a to assess complement activation during cardiac operations.
尽管肝素涂层体外循环可减少心脏手术期间的补体激活，这一点已得到充分证实，但关于替代途径和经典途径激活减少的体内信息却很少。
在一项前瞻性、随机研究中，纳入接受标准全量肝素化冠状动脉搭桥术的患者，我们将肝素涂层循环管路（Duraflo II）（10例患者）与未涂层循环管路（10例患者）进行比较，并通过检测iC3（C3b样C3）浓度评估补体激活起始程度，通过C4b/c（C4b、iC4b、C4c）浓度评估经典途径激活，通过可溶性C5b - 9浓度评估终末途径激活，通过C3a（C3a去精氨酸）和C3b/c（C3b、iC3b、C3c）浓度评估C3激活。
与未涂层循环管路相比，肝素涂层体外循环在体外循环结束时及硫酸鱼精蛋白给药后显著降低了循环补体激活产物C3b/c和可溶性C5b - 9浓度，但未降低iC3、C4b/c或C3a浓度。
肝素涂层体外循环通过替代补体途径减少补体激活，可能是在C3转化酶水平，进而减少终末途径激活。在评估心脏手术期间的补体激活时，C3b/c似乎比C3a是更敏感的标志物。
